Apparatus and systems for minimally invasive dissection of tissues

ABSTRACT

Electrosurgical lysing methods. In some implementations, the method may comprise delivering a lysing tip through an entrance incision into a patient&#39;s body, wherein the lysing tip comprises at least one bead comprising an at least substantially electrically non-conductive surface; and at least one lysing segment extending within a recess defined, at least in part, by the at least one bead. The at least one bead may protrude both distally and proximally relative to the at least one lysing segment. The method may further comprise forming opposing tissue planes using the lysing tip to create an implant pocket; and inserting an implant through the entrance incision and into the implant pocket.

RELATED APPLICATIONS

This application is a continuation of co-pending U.S. patent applicationSer. No. 17/187,527, which was filed on Feb. 26, 2021, which is acontinuation of U.S. patent application Ser. No. 16/827,677, which wasfiled on Mar. 23, 2020, which is a continuation of U.S. patentapplication Ser. No. 15/464,199, which was filed on Mar. 20, 2017 andclaims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional PatentApplication No. 62/313,707 filed on Mar. 26, 2016 titled “Apparatus &Systems For Minimally Invasive Dissection of Tissues via Cannula” andfurther claims the benefit under 35 U.S.C. § 119(e) of U.S. ProvisionalPatent Application No. 62/409,575 filed on Oct. 18, 2016 and titled“Apparatus, Systems, and Methods for Minimally Invasive Dissection ofTissues.” Each of the aforementioned applications is hereby incorporatedherein by reference in its entirety.

SUMMARY

Examples of certain preferred embodiments and implementations of theinvention are disclosed below in connection with the following numberedparagraphs.

-   -   1. An electrosurgical device configured for deployment through a        cannula, comprising:        -   a lysing tip configured for delivery of electrosurgical            energy, wherein the lysing tip comprises:            -   an energy delivery side configured to receive and                deliver electrosurgical energy for one or both of tissue                dissection and modification; and            -   an orientational-deployment side opposite from the                energy delivery side, wherein the                orientational-deployment side is configured to allow for                the lysing tip to be repositioned between a delivery                configuration in which the lysing tip can be positioned                within a lumen of the cannula with the energy delivery                side facing an interior surface of the lumen and a                treatment configuration in which the lysing tip is                positioned outside of the cannula such that the energy                delivery side extends at least substantially                perpendicular to an axis of the cannula; and        -   a deployment assembly coupled with the            orientational-deployment side of the lysing tip, wherein the            deployment assembly is configured to allow for selective            repositioning between the delivery configuration and the            treatment configuration.    -   2. The electrosurgical device of example 1, wherein the lysing        tip is configured is configured such that the energy delivery        side extends at least substantially parallel to the axis of the        cannula in the delivery configuration.    -   3. The electrosurgical device of example 1, wherein the lysing        tip is configured such that the energy delivery side extends at        an acute angle relative to the axis of the cannula in the        delivery configuration.    -   4. The electrosurgical device of example 1, wherein the        deployment assembly comprises a first actuation rod and a second        actuation rod coupled with the lysing tip.    -   5. The electrosurgical device of example 4, further comprising a        retraction guide configured to facilitate repositioning of the        lysing tip between the treatment configuration and the delivery        configuration.    -   6. The electrosurgical device of example 5, wherein the        retraction guide is configured to provide a restorative force to        the lysing tip by contacting the cannula when the lysing tip is        repositioned from the treatment configuration to the delivery        configuration.    -   7. The electrosurgical device of example 6, wherein the        retraction guide comprises a spring positioned on at least one        of the first actuation rod and the second actuation rod.    -   8. The electrosurgical device of example 4, further comprising        at least one canal configured to supply fluids to a surgical        site adjacent to the lysing tip during a surgical procedure.    -   9. The electrosurgical device of example 8, wherein the at least        one canal is configured to be selectively extended towards the        lysing tip and withdrawn from the lysing tip.    -   10. The electrosurgical device of example 4, wherein the first        actuation rod comprises a first hinge, and wherein the second        actuation rod comprises a second hinge.    -   11. The electrosurgical device of example 10, wherein the first        hinge and the second hinge are configured to allow the lysing        tip to be selectively rotated at least one of above and below a        cross-sectional profile of an opening at a distal end of the        cannula in the treatment configuration.    -   12. The electrosurgical device of example 1, further comprising        at least one energy window formed on at least one of an upper        surface and a lower surface of the lysing tip.    -   13. The electrosurgical device of example 12, wherein the at        least one energy window comprises a plurality of energy windows.    -   14. The electrosurgical device of example 13, wherein at least a        subset of the plurality of energy windows are at least one of        physically and energetically isolated from one another.    -   15. The electrosurgical device of example 14, wherein the at        least a subset of the plurality of energy windows is configured        to deliver a modality of energy that differs from at least a        second subset of the plurality of energy windows.    -   16. The electrosurgical device of example 1, wherein the lysing        tip comprises an antenna configured to provide location data        regarding the lysing tip.    -   17. The electrosurgical device of example 16, wherein the        antenna comprises an RFID tag.    -   18. The electrosurgical device of example 1, wherein the lysing        tip comprises a bipolar lysing tip configured to deliver bipolar        electrosurgical energy, and wherein the lysing tip comprises a        first set of lysing elements and a second set of lysing        elements, wherein the first set of lysing elements is        electrically isolated from the second set of lysing elements.    -   19. The electrosurgical device of example 18, wherein the lysing        tip comprises a first linking member electrically coupled to the        first set of lysing elements and a second linking member        electrically coupled to the second set of lysing elements, and        wherein the first linking member is electrically isolated from        the second linking member.    -   20. An electrosurgical system, comprising:        -   an electrosurgical device comprising a lysing tip having a            first end and a second end opposite from the first end,            wherein the lysing tip comprises:            -   a plurality of protrusions; and            -   at least one lysing segment positioned between at least                two adjacent protrusions in the plurality of                protrusions;        -   a cannula configured for delivery of the electrosurgical            device; and        -   a deployment assembly coupled with the electrosurgical            device, wherein the electrosurgical device and the            deployment assembly are configured such that the at least            one lysing segment is positioned to face an interior wall of            the cannula during delivery of the electrosurgical device,            and such that the at least one lysing segment can be rotated            after extending through a distal end of the cannula to allow            at least one of the first end and the second end to protrude            beyond a cross-sectional profile of an opening at the distal            end.    -   21. The electrosurgical system of example 20, wherein the        electrosurgical device and the deployment assembly are        configured such that the at least one lysing segment can be        rotated after extending through a distal end of the cannula to        allow both the first end and the second end of the lysing tip to        protrude beyond a cross-sectional profile of the opening at the        distal end.    -   22. The electrosurgical system of example 20, further comprising        a second cannula comprising a cross-sectional area greater than        a cross-sectional area of the cannula, wherein the second        cannula is configured to be positioned outside the cannula        during delivery of the electrosurgical device.    -   23. The electrosurgical system of example 22, wherein the        electrosurgical device is configured such that the plurality of        protrusions is unable to be fully received within the second        cannula.    -   24. The electrosurgical system of example 20, further comprising        a spot coagulator configured to extend through the cannula and        deliver electrosurgical energy therethrough.    -   25. The electrosurgical system of example 24, wherein the spot        coagulator is configured to be selectively movable relative to        the lysing tip.    -   26. The electrosurgical system of example 20, further comprising        means for fixing a rotational orientation of the lysing tip        relative to the cannula.    -   27. The electrosurgical system of example 26, wherein the means        for fixing a rotational orientation of the lysing tip relative        to the cannula is positioned on the cannula.    -   28. The electrosurgical system of example 26, wherein the means        for fixing a rotational orientation of the lysing tip relative        to the cannula comprises at least one slot formed in a distal        end of the cannula.    -   29. The electrosurgical system of example 28, wherein the at        least one slot is configured to receive at least a portion of        the lysing tip therein in a treatment configuration in which the        lysing tip is positioned outside of the cannula such that the        energy delivery side extends at least substantially        perpendicular to the axis of the cannula.    -   30. The electrosurgical system of example 20, wherein the at        least one lysing segment is made up of a cermet material.    -   31. The electrosurgical system of example 20, wherein the        deployment assembly comprises:        -   a first actuation rod; and        -   an intermediate hinge member coupled with the first            actuation rod and coupled with the lysing tip, wherein the            intermediate hinge member is configured such that actuation            of the first actuation rod results in pivoting of the lysing            rod between a delivery configuration in which the lysing tip            can be positioned within a lumen of the cannula with the at            least one lysing segment facing an interior surface of the            lumen and a treatment configuration in which the lysing tip            is positioned with at least one of the first end and the            second end protruding beyond a cross-sectional profile of            the opening of the cannula at the distal end.    -   32. The electrosurgical system of example 31, wherein the        intermediate hinge member is coupled with the lysing tip in        between two opposing ends of the lysing tip.    -   33. The electrosurgical system of example 32, wherein the lysing        tip further comprising a linking member positioned along a        proximal side of the lysing tip, and wherein the intermediate        hinge member is coupled with the linking member.    -   34. The electrosurgical system of example 32, wherein the        deployment assembly further comprises a second actuation rod.    -   35. The electrosurgical system of example 34, wherein the second        actuation rod is pivotably coupled to the lysing tip.    -   36. The electrosurgical system of example 35, wherein the second        actuation rod is pivotably coupled to the lysing tip at one end        of the two opposing ends of the lysing tip.    -   37. The electrosurgical system of example 31, wherein the        intermediate hinge member is coupled with the lysing tip at one        end of two opposing ends of the lysing tip.    -   38. The electrosurgical system of example 37, wherein the        deployment assembly further comprises a second actuation rod.    -   39. The electrosurgical system of example 38, wherein the second        actuation rod is configured to advance and withdraw the lysing        tip within the cannula.    -   40. The electrosurgical system of example 39, wherein the second        actuation rod is coupled with the lysing tip along a central        portion of the lysing tip between the two opposing ends.    -   41. A surgical system, comprising:        -   a surgical lysing tip comprising:            -   a treatment side; and            -   an orientational-deployment side opposite from the                treatment side, wherein the surgical lysing tip                comprises a lysing tip axis extending at least                substantially along the treatment side and along the                orientational-deployment side;        -   a cannula configured for delivery of the surgical lysing            tip, wherein the cannula comprises a cannula axis; and        -   a deployment assembly coupled with the            orientational-deployment side of the surgical lysing tip and            configured to pivot the surgical lysing tip following            delivery of the surgical lysing tip through a distal opening            of the cannula, wherein the deployment assembly is            configured to allow the surgical lysing tip to be delivered            through the cannula along the cannula axis such that the            lysing tip axis is at least substantially aligned with the            cannula axis during delivery, and wherein the deployment            assembly is configured to allow the surgical lysing tip to            be selectively pivoted after the surgical lysing tip has            passed through the distal opening such that the lysing tip            axis is positioned at an angle with respect to the cannula            axis and such that at least one of two opposing ends of the            surgical lysing tip defining the lysing tip axis protrudes            beyond a cross-sectional profile of the distal opening of            the cannula.    -   42. The surgical system of example 41, wherein the surgical        system is configured to allow the surgical lysing tip to be        selectively pivoted after the surgical lysing tip has passed        through the distal opening such that the lysing tip axis is        positioned at an angle with respect to the cannula axis and such        that both of the two opposing ends of the surgical lysing tip        defining the lysing tip axis protrude beyond the cross-sectional        profile of the distal opening of the cannula.    -   43. An electrosurgical device, comprising:        -   a lysing tip comprising:            -   a plurality of beads;            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads;                and            -   a tunnel extending at least partially through each of                the plurality of beads, wherein the at least one lysing                member is positioned to extend at least partially                through the tunnel to define the at least one lysing                segment between each pair of adjacent beads.    -   44. The electrosurgical device of example 43, wherein each of        the plurality of beads is non-symmetrical relative to an axis        defined by the at least one lysing member.    -   45. The electrosurgical device of example 43, wherein the lysing        tip comprises a plurality of lysing segments.    -   46. The electrosurgical device of example 44, wherein each of        the plurality of lysing segments is formed by a single lysing        member.    -   47. The electrosurgical device of example 44, wherein at least        one lysing segment of the plurality of lysing segments extends        at an angle relative to at least one other lysing segment of the        plurality of lysing segments.    -   48. The electrosurgical device of example 47, wherein the        plurality of lysing segments extend in an arced shape along a        treatment side of the lysing tip.    -   49. The electrosurgical device of example 48, wherein at least a        first lysing segment of the plurality of lysing segments extends        in a first direction, wherein at least a second lysing segment        of the plurality of lysing segments extends in a second        direction angled towards a first side of the lysing tip relative        to the first direction, and wherein at least a third lysing        segment of the plurality of lysing segments extends in a third        direction angled towards a second side of the lysing tip        opposite from the first side relative to the first direction.    -   50. The electrosurgical device of example 43, wherein each of at        least a subset of the plurality of beads comprises a plurality        of facets formed thereon.    -   51. The electrosurgical device of example 50, wherein each of        the at least a subset of the plurality of beads comprises facets        formed on leading surfaces of the beads, and wherein the facets        are configured to facilitate movement of the lysing tip between        tissue layers during a surgical procedure.    -   52. The electrosurgical device of example 51, wherein each of        the at least a subset of the plurality of beads comprises a        first facet formed on an upper leading surface and a second fact        formed on a lower leading surface, and wherein the upper leading        surface is angled towards the lower leading surface so as to        form a wedge shape.    -   53. The electrosurgical device of example 43, wherein each of at        least a subset of the plurality of beads comprises a        substantially flattened trailing end.    -   54. The electrosurgical device of example 53, wherein the at        least a subset of the plurality of beads comprises a        substantially frusto-ellipsoidal shape.    -   55. The electrosurgical device of example 43, wherein each of at        least a subset of the plurality of beads comprises a        substantially ellipsoidal shape.    -   56. The electrosurgical device of example 55, wherein each of        the plurality of beads comprises a substantially ellipsoidal        shape.    -   57. The electrosurgical device of example 43, further comprising        a first actuation rod coupled adjacent to a first end of the        lysing tip and a second actuation rod coupled adjacent to a        second end of the lysing tip opposite from the first end.    -   58. The electrosurgical device of example 57, wherein the first        actuation rod and the second actuation rod are configured to        pivot the lysing tip between a delivery configuration and a        treatment configuration.    -   59. The electrosurgical device of example 58, wherein the lysing        tip is configured to be delivered through a cannula with the        first actuation rod and the second actuation rod extending        through the cannula, wherein the electrosurgical device is        configured such that the lysing tip cannot be fully received in        the cannula in the treatment configuration.    -   60. The electrosurgical device of example 59, wherein the        electrosurgical device is configured so as to extend the lysing        tip at an angle relative to an axis of the cannula in the        delivery configuration, and wherein the electrosurgical device        is configured such that the lysing tip can be fully received in        the cannula in the delivery configuration.    -   61. The electrosurgical device of example 60, wherein at least        one of the first actuation rod and the second actuation rod        comprises a first bend at or near a distal end of the at least        one of the first actuation rod and the second actuation rod.    -   62. The electrosurgical device of example 61, wherein the first        bend defines a widened area for receipt of a portion of the        lysing tip during repositioning of the lysing tip between the        treatment configuration and the delivery configuration.    -   63. The electrosurgical device of example 62, wherein the at        least one of the first actuation rod and the second actuation        rod comprises a second bend positioned distally of the first        bend, and wherein the second bend extends in a direction        opposite of the first bend.    -   64. The electrosurgical device of example 58, wherein the first        actuation rod comprises a first opening for receiving a first        end of the lysing member therethrough, and wherein the second        actuation rod comprises a second opening for receiving a second        end of the lysing member opposite from the first end        therethrough.    -   65. The electrosurgical device of example 64, wherein the first        opening is elongated to allow the lysing member to pivot within        the first opening as the lysing tip is repositioned between the        treatment configuration and the delivery configuration.    -   66. The electrosurgical device of example 65, wherein the first        opening is elongated at least substantially in a direction of an        axis of the first actuation rod.    -   67. The electrosurgical device of example 43, wherein at least a        subset of the plurality of beads is configured to rotate about        the at least one lysing member.    -   68. The electrosurgical device of example 67, wherein the at        least a subset of the plurality of beads is configured to rotate        in an upward direction relative to the lysing tip within a range        of between about 2 degrees and about 110 degrees, and wherein        the at least a subset of the plurality of beads is configured to        rotate in a downward direction relative to the lysing tip within        a range of between about 2 degrees and about 110 degrees.    -   69. The electrosurgical device of example 67, wherein each of        the plurality of beads is configured to be independently        rotatable about the at least one lysing member with respect to        the other beads of the plurality of beads.    -   70. The electrosurgical device of example 64, wherein the first        opening comprises internal beveling adjacent to the first        opening, and wherein the internal beveling is configured to        facilitate pivoting of the lysing tip between the treatment        configuration and the delivery configuration.    -   71. The electrosurgical device of example 43, further        comprising:        -   a first coupling tip at a first end of the at least one            lysing member; and        -   a second coupling tip at a second end of the at least one            lysing member opposite from the first end, wherein the first            coupling tip and the second coupling tip are configured to            secure the at least one lysing member to two outermost beads            of the plurality of beads.    -   72. The electrosurgical device of example 71, wherein the first        coupling tip differs from the second coupling tip.    -   73. The electrosurgical device of example 71, wherein the first        coupling tip comprises a weld defining a cross-sectional        dimension greater in at least one direction that a        cross-sectional dimension of the at least one lysing member.    -   74. The electrosurgical device of example 43, further comprising        a plurality of spacers coupled with the at least one lysing        member, wherein each of the plurality of spacers is positioned        between two adjacent beads of the plurality of beads.    -   75. The electrosurgical device of example 74, wherein the at        least one lysing member comprises a single lysing rod.    -   76. The electrosurgical device of example 75, wherein the single        lysing rod comprises a circular shape in cross section.    -   77. The electrosurgical device of example 75, wherein each of        the plurality of spacers comprises an opening configured to        receive a portion of the single lysing rod therethrough.    -   78. The electrosurgical device of example 77, wherein the single        lysing rod has a cross-sectional shape that differs from a        cross-sectional shape of an exterior surface of each of the        plurality of spacers.    -   79. The electrosurgical device of example 74, wherein each of        the plurality of spacers comprises a leading edge for delivery        of electrosurgical energy from the at least one lysing member.    -   80. The electrosurgical device of example 79, wherein each of        the plurality of spacers comprises only a single edge.    -   81. The electrosurgical device of example 80, wherein, other        than the single edge, each of the plurality of spacers comprises        an at least substantially smooth exterior surface such that at        least substantially all of the electrosurgical energy from the        at least one lysing member is delivered through the single edge.    -   82. The electrosurgical device of example 74, wherein each of        the plurality of spacers comprises a conductive material such        that electrosurgical energy from the at least one lysing member        can be delivered through the spacers.    -   83. The electrosurgical device of example 74, wherein each of        the plurality of spacers comprises an insulating material, and        wherein each of the plurality of spacers comprises one or more        openings configured to allow for delivery of electrosurgical        energy through the one or more openings.    -   84. The electrosurgical device of example 74, wherein the at        least one lysing member comprises a lysing rod having a circular        cross-sectional shape, and wherein each of the plurality of        spacers is crimped onto the lysing rod in between two adjacent        beads of the plurality of beads.    -   85. The electrosurgical device of example 74, wherein the        spacers are configured to at least substantially prevent        rotation of the plurality of beads with respect to the at least        one lysing member.    -   86. The electrosurgical device of example 74, wherein the        spacers are configured to selectively limit an amount of        rotation of the plurality of beads with respect to the at least        one lysing member.    -   87. The electrosurgical device of example 43, further comprising        a plurality of protuberances formed on the at least one lysing        member, wherein the plurality of protuberances are configured to        confine each of the plurality of beads to a predetermined region        relative to the at least one lysing member.    -   88. The electrosurgical device of example 87, wherein the        plurality of protuberances comprise welds formed on the at least        one lysing member.    -   89. The electrosurgical device of example 43, wherein the at        least one lysing member comprises a single lysing rod.    -   90. The electrosurgical device of example 89, wherein the lysing        rod comprises a leading edge for delivery of electrosurgical        energy.    -   91. The electrosurgical device of example 90, wherein the lysing        rod comprises only a single edge.    -   92. The electrosurgical device of example 91, wherein, other        than the single edge, the lysing rod comprises an at least        substantially smooth exterior surface.    -   93. The electrosurgical device of example 89, wherein the lysing        rod comprises a polygonal shape in cross section.    -   94. The electrosurgical device of example 93, wherein the lysing        rod comprises at least one of a pentagonal and a hexagonal shape        in cross section.    -   95. The electrosurgical device of example 43, wherein each of        the plurality of beads comprises an identical shape.    -   96. The electrosurgical device of example 43, wherein two        opposing outer beads of the plurality of beads comprise a first        shape, and wherein at least one inner bead of the plurality of        beads comprises a second shape that differs from the first        shape.    -   97. The electrosurgical device of example 43, wherein each of at        least a subset of the plurality of beads comprises a        substantially ellipsoidal shape.    -   98. The electrosurgical device of example 43, wherein each of at        least a subset of the plurality of beads comprises an annular        bead structure.    -   99. The electrosurgical device of example 98, wherein each of        the at least a subset of the plurality of beads comprises a bead        hub positioned within the annular bead structure.    -   100. The electrosurgical device of example 99, wherein each of        the bead hubs is configured to couple the bead with the at least        one lysing member.    -   101. The electrosurgical device of example 43, wherein each of        at least a subset of the plurality of beads comprises a trailing        end and a leading end, wherein the trailing end comprises a        rougher surface than the leading end.    -   102. An electrosurgical device, comprising:        -   a lysing tip comprising a treatment side and an            orientational-deployment side opposite from the treatment            side, wherein the lysing tip further comprises:            -   a plurality of beads; and            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads,                wherein the at least one lysing segment defines a                coupling axis with the plurality of beads, and wherein                the lysing tip comprises an open region lacking                structure on the orientational-deployment side such that                at least some of the plurality of beads protrudes from        -   the treatment side and from the orientational-deployment            side of the lysing tip.    -   103. An electrosurgical device, comprising:        -   a lysing tip comprising a treatment side and an            orientational-deployment side opposite from the treatment            side, wherein the lysing tip further comprises:            -   a plurality of beads;            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads,                wherein the at least one lysing segment defines a                coupling axis with the plurality of beads; and            -   a support member extending between a first outer bead of                the plurality of beads and a second outer bead of the                plurality of beads opposite from the first outer bead on                the orientational-deployment side, wherein the support                member is configured to facilitate coupling of the                lysing tip to a surgical tool used to control the lysing                tip during a surgical procedure within a patient's body.    -   104. The electrosurgical device of example 103, further        comprising a grasping pad configured to engage at least one jaw        of the surgical tool.    -   105. The electrosurgical device of example 104, wherein at least        a portion of the grasping pad is electrically coupled to the at        least one lysing member such that the grasping pad is configured        to receive electrosurgical energy from the surgical tool and        transfer the electrosurgical energy to the at least one lysing        segment.    -   106. The electrosurgical device of example 104, wherein the        grasping pad is formed on the support member.    -   107. The electrosurgical device of example 105, wherein the        grasping pad comprises a hole configured to receive a projection        extending from the at least one jaw of the surgical tool.    -   108. The electrosurgical device of example 107, wherein the        grasping pad is coated with an insulating coating, wherein the        hole is uncoated, and wherein the at least a portion of the        grasping pad comprises the hole.    -   109. An electrosurgical system, comprising:        -   a lysing tip comprising a treatment side and an            orientational-deployment side opposite from the treatment            side, wherein the lysing tip further comprises:            -   a plurality of beads;            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads,                wherein the at least one lysing member defines a                coupling axis with the plurality of beads; and            -   a cannula configured for delivery of the lysing tip                therethrough into a patient's body, wherein the cannula                comprises a cannula axis, and wherein the system is                configured such that the lysing tip can be delivered                through the cannula with the coupling axis aligned with                the cannula axis.    -   110. The electrosurgical system of example 109, further        comprising a second cannula, wherein the second cannula        comprises a lumen having a smaller cross-sectional dimension        that the cannula such that the second cannula can fit within the        cannula, and wherein the lysing tip is configured such that the        plurality of beads is unable to be fully received within the        second cannula with the coupling axis aligned with the cannula        axis.    -   111. An electrosurgical system, comprising:        -   a lysing tip comprising a treatment side and an            orientational-deployment side opposite from the treatment            side, wherein the lysing tip further comprises:            -   a plurality of beads;            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads,                wherein the lysing tip comprises a primary axis                extending between a first outer bead of the plurality of                beads and a second outer bead of the plurality of beads,                and wherein each of the plurality of beads comprises a                tip extending at least substantially perpendicular to                the primary axis; and            -   a cannula configured for delivery of the lysing tip                therethrough into a patient's body, wherein the cannula                comprises a cannula axis, and wherein the system is                configured such that the lysing tip can be delivered                through the cannula with the primary axis aligned with                the cannula axis.    -   112. An electrosurgical system, comprising:        -   a lysing tip comprising a treatment side and a grasping pad            opposite from the treatment side, wherein the treatment side            is configured to receive and deliver electrosurgical energy            for tissue one or both of dissection and modification; and        -   a first instrument configured to selectively couple with the            lysing tip, wherein the first instrument is configured to            deliver electrosurgical energy to the treatment side of the            lysing tip while the lysing tip is coupled with the first            instrument, and wherein the first instrument is configured            to selectively couple with the lysing tip at the grasping            pad.    -   113. The electrosurgical system of example 112, wherein the        lysing tip comprises:        -   a plurality of protrusions;        -   at least one lysing member defining at least one lysing            segment between each pair of adjacent protrusions of the            plurality of protrusions.    -   114. The electrosurgical system of example 112, wherein the        lysing tip further comprises:        -   a plurality of beads; and        -   a lysing rod extending at least partially through each of            the plurality of beads so as to define a plurality of lysing            segments extending between adjacent beads of the plurality            of beads.    -   115. The electrosurgical system of example 114, wherein the        lysing tip further comprises a support member coupled to the        lysing rod at opposite ends of the support member.    -   116. The electrosurgical system of example 115, wherein the        lysing tip further comprises a grasping pad formed on the        support member, and wherein the first instrument comprises at        least one jaw configured to engage the grasping pad.    -   117. The electrosurgical system of example 116, wherein the at        least one jaw comprises an upper jaw and a lower jaw, and        wherein at least one of the upper jaw and the lower jaw is        movable such that the upper jaw and the lower jaw are configured        to open to receive the grasping pad and to close to fixedly        couple the grasping pad in between the upper jaw and the lower        jaw.    -   118. The electrosurgical system of example 116, wherein the at        least one jaw comprises a projection, wherein the grasping pad        comprises an opening configured to receive the projection.    -   119. The electrosurgical system of example 118, wherein the        first instrument is configured to deliver electrosurgical energy        from the projection, through the opening, and into the lysing        rod.    -   120. The electrosurgical system of example 119, wherein the        grasping pad comprises a non-conductive insulation, and wherein        the at least one jaw comprises a non-conductive insulation.    -   121. The electrosurgical system of example 120, wherein the        projection lacks the non-conductive insulation, and wherein the        opening lacks the non-conductive insulation.    -   122. The electrosurgical system of example 120, wherein the        non-conductive insulation comprises a coating.    -   123. The electrosurgical system of example 113, wherein the        plurality of protrusions comprises a plurality of beads        positioned along the at least one lysing member.    -   124. The electrosurgical system of example 114, wherein each of        the plurality of beads is independently movable at least one of        laterally and rotationally with respect to the at least one        lysing member.    -   125. The electrosurgical system of example 114, wherein at least        a subset of the plurality of beads protrudes both distally in a        direction of the treatment side and proximally in a direction        opposite of the direction of the treatment side relative to the        at least one lysing member.    -   126. The electrosurgical system of example 114, wherein each of        the plurality of beads protrudes both distally in a direction of        the treatment side and proximally in a direction opposite of the        direction of the treatment side relative to the at least one        lysing member.    -   127. The electrosurgical system of example 112, wherein the        first instrument comprises a jaw configured to receive the        grasping pad of the lysing tip to couple the lysing tip to the        first instrument.    -   128. The electrosurgical system of example 127, wherein the        grasping pad comprises a magnet, and wherein the jaw comprises a        magnetic element configured to engage the magnet.    -   129. The electrosurgical system of example 127, wherein the jaw        comprises an insulated exterior surface, and wherein at least a        portion of an interior surface of the jaw configured to engage        the grasping pad is uninsulated to allow for delivery of        electrosurgical energy through the jaw to the grasping pad and        to the treatment side of the lysing tip.    -   130. The electrosurgical system of example 127, wherein the jaw        is configured to open to facilitate receiving the grasping pad,        and wherein the jaw is configured to close to grasp the grasping        pad.    -   131. The electrosurgical system of example 127, wherein the jaw        comprises a projection, wherein the grasping pad comprises a        hole, and wherein the projection is configured to be received in        the hole to facilitate a more stable coupling of the lysing tip        with the first instrument.    -   132. The electrosurgical system of example 131, wherein the jaw        is insulated, and wherein the projection is uninsulated to allow        for delivery of electrosurgical energy through the projection to        the grasping pad and to the treatment side of the lysing tip.    -   133. The electrosurgical system of example 112, further        comprising a second instrument configured to facilitate coupling        of the lysing tip to the first instrument.    -   134. The electrosurgical system of example 133, further        comprising:        -   a first cannula configured to deliver the first instrument            and the lysing tip into a patient's body; and        -   a second cannula configured to deliver the second instrument            into the patient's body.    -   135. The electrosurgical system of example 133, wherein the        second instrument lacks the ability to deliver electrosurgical        energy.    -   136. The electrosurgical system of example 133, wherein the        first instrument comprises a jaw, wherein the second instrument        comprises a jaw, and wherein the jaw of the first instrument is        identical to the jaw of the second instrument.    -   137. The electrosurgical system of example 112, further        comprising a first cannula configured to deliver the first        instrument and the lysing tip into a patient's body.    -   138. The electrosurgical system of example 112, further        comprising a linking member positioned opposite from the        treatment side, wherein the linking member is configured to        facilitate coupling of the lysing tip with the first instrument.    -   139. The electrosurgical system of example 138, wherein the        grasping pad extends from the linking member.    -   140. The electrosurgical system of example 112, wherein the        first instrument comprises at least one of means for grasping        the lysing tip and means for controlling the lysing tip during a        surgical procedure.    -   141. The electrosurgical system of example 140, wherein the        first instrument comprises means for grasping the lysing tip,        and wherein the means for grasping the lysing tip comprises a        pair of jaws configured to receive the grasping pad.    -   142. The electrosurgical system of example 141, wherein at least        one jaw of the pair of jaws is movable.    -   143. The electrosurgical system of example 112, further        comprising a tether coupled with the lysing tip, wherein the        tether is configured to facilitate coupling of the lysing tip        with the first instrument.    -   144. The electrosurgical system of example 143, wherein the        tether is coupled with the grasping pad of the lysing tip.    -   145. The electrosurgical system of example 144, wherein the        first instrument comprises a jaw configured to receive the        grasping pad of the lysing tip to couple the lysing tip to the        first instrument, and wherein the tether extends through an        opening formed in the jaw.    -   146. The electrosurgical system of example 143, wherein the        tether is configured to, upon being retracted, direct the lysing        tip into an engagement feature of the first instrument.    -   147. The electrosurgical system of example 146, wherein the        engagement feature comprises a jaw.    -   148. The electrosurgical system of example 112, wherein the        first instrument comprises at least one jaw, wherein the at        least one jaw is configured to engage the grasping pad of the        lysing tip, and wherein the system is configured such that the        first instrument delivers electrosurgical energy from the at        least one jaw, through the grasping pad, and into a plurality of        lysing segments on the treatment side.    -   149. The electrosurgical system of example 148, further        comprising a slot formed in the at least one jaw, wherein the        slot is configured to receive at least a portion of the grasping        pad.    -   150. The electrosurgical system of example 149, wherein the at        least one jaw is configured to open and shut, and wherein the        slot is configured to enclose the grasping pad about at least 3        sides of the grasping pad and at least partially about a fourth        side of the grasping pad when the at least one jaw is closed        with the grasping pad positioned therein.    -   151. The electrosurgical system of example 149, wherein the at        least one jaw comprises at least one of an insulating cover and        an insulating coating, and wherein at least a portion of the        slot lacks the at least one of an insulating cover and an        insulating coating so as to allow for transfer of        electrosurgical energy therethrough.    -   152. A method for use of an electrosurgical device, the method        comprising the steps of:        -   delivering a lysing tip through a first cannula into a            patient's body;        -   advancing the lysing tip beyond a distal opening of the            first cannula;        -   delivering a first instrument through a second cannula into            the patient's body adjacent to the lysing tip;        -   coupling the lysing tip with the first instrument;        -   advancing a second instrument through the first cannula into            the patient's body such that at least a distal end of the            second instrument protrudes beyond the distal opening of the            first cannula;        -   using the first instrument to couple the lysing tip with the            second instrument;        -   releasing the lysing tip from the first instrument; and        -   using the second instrument to perform a surgical procedure            with the lysing tip.    -   153. The method of example 152, wherein the second instrument        comprises at least one jaw configured to engage a first portion        of the lysing tip, and wherein the step of using the first        instrument to couple the lysing tip with the second instrument        comprises advancing the first portion of the lysing tip into the        at least one jaw.    -   154. The method of example 153, wherein the step of using the        first instrument to couple the lysing tip with the second        instrument further comprises closing the at least one jaw to        secure the first portion of the lysing tip therein.    -   155. The method of example 153, wherein the first portion of the        lysing tip comprises a grasping pad protruding from a proximal        side of the lysing tip.    -   156. The method of example 155, wherein lysing tip comprises an        energy delivery side opposite from the proximal side, and        wherein the second instrument is configured to deliver        electrosurgical energy through the grasping pad to the energy        delivery side when the second instrument is coupled with the        lysing tip.    -   157. The method of example 153, wherein the first instrument        comprises at least one jaw configured to engage a second portion        of the lysing tip distinct from the first portion.    -   158. The method of example 148, wherein the step of advancing        the lysing tip beyond a distal opening of the first cannula is        performed using the second instrument.    -   159. The method of example 148, wherein the second instrument is        configured to deliver electrosurgical energy to the lysing tip        when the second instrument is coupled with the lysing tip.    -   160. The method of example 159, wherein the first instrument        lacks the ability to deliver electrosurgical energy.    -   161. An electrosurgical system, comprising:        -   a lysing tip comprising a treatment side and an            orientational-deployment side opposite from the treatment            side, wherein the lysing tip further comprises:            -   a plurality of beads, wherein each of the plurality of                beads extends from the treatment side towards the                orientational-deployment side, and wherein the plurality                of beads collectively defines a lysing tip axis                extending between two outer beads of the plurality of                beads; and            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads,                wherein the at least one lysing member defines a                coupling axis with the plurality of beads;            -   a cannula comprising a lumen configured to deliver the                lysing tip therethrough; and            -   at least one actuation rod coupled with the lysing tip,                wherein the at least one actuation rod is configured to                reorient the lysing tip between a delivery configuration                in which the lysing tip axis extends through the lumen                and a treatment configuration in which the lysing tip                axis extends at least substantially perpendicular to an                axis of the lumen outside of a distal end of the                cannula.    -   162. The system of example 161, wherein the lysing tip comprises        an open region lacking structure on the orientational-deployment        side proximal to the at least one lysing member and the        plurality of beads.    -   163. The system of example 161, wherein the lysing tip is        configured such that at least a subset of the plurality of beads        protrude from the treatment side and at least a subset of the        plurality of beads protrude from the orientational-deployment        side.    -   164. The system of example 161, wherein the at least one lysing        member comprises a lysing plate, and wherein the lysing plate        extends along the lysing tip axis.    -   165. The system of example 164, wherein the lysing tip is        configured such that the lysing plate extends through each of        the plurality of beads, and such that the lysing plate alone        supports each of the plurality of beads on the lysing tip.    -   166. The system of example 161, wherein the electrosurgical        system is configured such that the lysing tip axis extends at        least substantially parallel to the axis of the lumen in the        delivery configuration.    -   167. The system of example 161, wherein the electrosurgical        system is configured such that at least one of the two outer        beads of the plurality of beads extends beyond a cross-sectional        profile of an opening at the distal end of the cannula in the        treatment configuration.    -   168. The system of example 167, where the electrosurgical system        is configured such that both of the two outer beads of the        plurality of beads extends beyond a cross-sectional profile of        an opening at the distal end of the cannula in the treatment        configuration.    -   169. The system of example 161, further comprising a second        cannula, wherein the second cannula comprises a lumen having a        smaller cross-sectional size than the cannula, and wherein the        second cannula is configured to be received within the cannula.    -   170. The system of example 169, wherein the lysing tip is        configured such that none of the plurality of beads is        configured to be fully received within the second cannula in        either the delivery or treatment configurations.    -   171. The system of example 161, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod.    -   172. The system of example 171, wherein the first actuation rod        comprises a distal portion coupled to the lysing tip, wherein        the distal portion extends at least substantially parallel to        the lysing tip axis.    -   173. The system of example 172, wherein the distal portion        extends at least substantially perpendicular to a proximal        portion of the first actuation rod.    -   174. The system of example 173, wherein the at least one lysing        member comprises a lysing plate, and wherein the distal portion        is coupled directly to the lysing plate.    -   175. The system of example 174, wherein the distal portion is        pivotably coupled to the lysing plate.    -   176. The system of example 175, further comprising a pivot        member for coupling the lysing plate to the first actuation rod.    -   177. The system of example 161, further comprising a horizontal        tunnel extending through each of the plurality of beads, wherein        the at least one lysing member is positioned to extend at least        partially through the horizontal tunnel.    -   178. The system of example 177, wherein the at least one lysing        member comprises a lysing plate, and wherein the lysing plate        extends through the horizontal tunnel to define a plurality of        lysing segments between each pair of adjacent beads.    -   179. The system of example 177, wherein each of the plurality of        beads comprises a vertical tunnel extending between an upper end        of the bead and a lower end of the bead.    -   180. The system of example 179, further comprising a plurality        of pins, wherein each of the plurality of pins extends through        one of the vertical tunnels, and wherein each of the plurality        of pins also extends through an opening formed in the lysing        plate to secure the plurality of beads to the lysing plate.    -   181. The system of example 161, wherein the at least one        actuation rod comprises a hinge structure.    -   182. The system of example 179, wherein the hinge structure is        configured to allow the lysing tip to be rotated at least one of        above and below a cross-sectional profile of an opening at the        distal end of the cannula in the treatment configuration.    -   183. The system of example 182, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod, wherein the first actuation rod comprises a first        hinge structure, and wherein the second actuation rod comprises        a second hinge structure.    -   184. The system of example 183, wherein both the first and        second hinge structures are configured to allow the lysing tip        to be rotated either above or below the cross-sectional profile        of the opening at the distal end of the cannula in the treatment        configuration.    -   185. The system of example 161, further comprising a second        cannula, wherein the second cannula comprises a lumen having a        smaller cross-sectional size than the cannula, wherein the        second cannula is configured to be received within the cannula,        and wherein the lysing tip is configured such that the plurality        of beads is configured to be fully received within the cannula        and the second cannula in the delivery configuration.    -   186. The system of example 161, wherein the lysing tip further        comprises a support member coupled to the at least one lysing        member and extending along the orientational-deployment side of        the lysing tip, wherein the support member is configured to        facilitate coupling of the lysing tip with the at least one        actuation rod.    -   187. The system of example 186, wherein the support member is        coupled to the at least one lysing member adjacent to the two        outer beads.    -   188. The system of example 187, wherein the support member is        coupled to the at least one lysing member adjacent to respective        inner surfaces of the two outer beads.    -   189. The system of example 186, wherein the support member is        formed in a bow shape from a first end of the support member        coupled with the at least one lysing member to a second end of        the support member coupled with the at least one lysing member        opposite from the first end.    -   190. The system of example 189, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod, wherein the support member comprises a first hole        configured to receive a first coupling member for coupling the        first actuation rod to the support member, and wherein the        support member further comprises a second hole configured to        receive a second coupling member for coupling the second        actuation rod to the support member.    -   191. The system of example 190, wherein the first coupling        member comprises a pin, and wherein the second coupling member        comprises a pin.    -   192. The system of example 190, wherein the first hole is offset        from the second hole with respect to at least one central axis        of the lysing tip.    -   193. The system of example 192, wherein the first hole is offset        from the second hole with respect to at least one of a central        axis defined by the at least one lysing member and a central        axis of the lysing tip extending between the treatment side and        the orientational-deployment side of the lysing tip.    -   194. The system of example 193, wherein the first hole is        positioned a first distance from the at least one lysing member,        wherein the second hole is positioned a second distance from the        at least one lysing member, and wherein the first distance        differs from the second distance.    -   195. The system of example 186, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod, wherein the support member comprises a first hole        configured to receive a first pin for coupling the first        actuation rod to the support member, and wherein the support        member further comprises a second hole configured to receive a        second pin for coupling the second actuation rod to the support        member.    -   196. The system of example 195, wherein the support member is        formed with a first knob protruding from the support member, and        wherein the first hole is formed in the first knob.    -   197. The system of example 196, wherein the support member is        formed with a second knob protruding from the support member,        and wherein the second hole is formed in the second knob.    -   198. The system of example 197, wherein the support member is        formed in a bow shape from a first end of the support member        coupled with the at least one lysing member to a second end of        the support member coupled with the at least one lysing member        opposite from the first end.    -   199. The system of example 161, wherein the at least one        actuation rod comprises a lysing tip receptacle configured to at        least partially receive the lysing tip when the lysing tip is        repositioned from the treatment configuration to the delivery        configuration.    -   200. The system of example 199, wherein the lysing tip further        comprises a support member coupled to the at least one lysing        member and extending along the orientational-deployment side of        the lysing tip, wherein the support member is configured to        facilitate coupling of the lysing tip with the at least one        actuation rod, and wherein the lysing tip receptacle is        configured to receive the support member.    -   201. The system of example 199, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod, and wherein the lysing tip receptacle comprises a        cutout region formed in the first actuation rod.    -   202. The system of example 161, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod, wherein the first actuation rod comprises a        distal portion and a proximal portion, wherein the second        actuation rod comprises a distal portion and a proximal portion,        and wherein the distal portions of the first and second        actuation rods are configured to pivot with respect to the        proximal portions of the first and second actuation rods.    -   203. The system of example 202, wherein the first actuation rod        comprises a first hinge member configured to pivot the proximal        portion of the first actuation rod with respect to the distal        portion of the first actuation rod, wherein the second actuation        rod comprises an opening configured to at least partially        receive the first hinge member while the lysing tip is in the        delivery configuration.    -   204. The system of example 203, wherein the first actuation rod        further comprises a lysing tip receptacle configured to at least        partially receive the lysing tip when the lysing tip is        repositioned from the treatment configuration to the delivery        configuration.    -   205. The system of example 161, wherein the lysing tip and the        cannula are configured such that the lysing tip may be fully        received within the cannula in the delivery configuration.    -   206. The system of example 205, wherein the electrosurgical        system is configured such that the lysing tip axis extends at an        angle with respect to the axis of the lumen of the cannula in        the delivery configuration.    -   207. The system of example 161, wherein the at least one lysing        member comprises a single lysing member, wherein the single        lysing member defines a plurality of lysing segments, and        wherein each lysing segment extends between an adjacent pair of        beads of the plurality of beads.    -   208. The system of example 207, further comprising a plurality        of spacers, wherein each spacer of the plurality of spacers is        coupled with a lysing segment of the plurality of lysing        segments.    -   209. The system of example 208, wherein each of the plurality of        spacers is configured to confine each of the plurality of beads        to a predetermined region relative to the single lysing member.    -   210. The system of example 207, further comprising a plurality        of protuberances coupled with the single lysing member, wherein        each of the plurality of lysing segments comprises a first        protuberance at a first end of the lysing segment and a second        protuberance at a second end of the lysing segment.    -   211. The system of example 207, wherein the single lysing member        comprises a non-circular shape in cross section along at least a        portion of the single lysing member.    -   212. The system of example 211, wherein the single lysing member        comprises a non-circular shape in cross section only at        locations corresponding with each of the plurality of beads.    -   213. The system of example 211, wherein the single lysing member        comprises a non-circular shape in cross section along an entire        length of the single lysing member.    -   214. The system of example 161, wherein each of the plurality of        beads has an at least substantially identical length extending        between the treatment side and the orientational-deployment        side.    -   215. The system of example 161, wherein the at least one        actuation rod comprises a first actuation rod and a second        actuation rod, wherein at least one of the first actuation rod        and the second actuation rod comprises a retraction guide        configured to facilitate repositioning of the lysing tip between        the treatment configuration and the delivery configuration.    -   216. The system of example 215, wherein the retraction guide is        configured to provide a restorative force to the lysing tip by        contacting the cannula when the lysing tip is repositioned from        the treatment configuration to the delivery configuration.    -   217. The system of example 216, wherein the retraction guide        comprises a spring positioned on the first actuation rod.    -   218. The system of example 216, wherein the retraction guide        extends from the first actuation rod by a first distance,        wherein at least one bead of the plurality of beads extends from        the first actuation rod in the delivery configuration by a        second distance, and wherein the first distance is at least one        of approximately equal to and slightly greater than the second        distance.    -   219. The system of example 218, wherein the first distance is        between about 1% and about 10% greater than the second distance.    -   220. The system of example 161, further comprising a protective        sleeve configured to encase the lysing tip during delivery.    -   221. The system of example 220, wherein the protective sleeve is        removable such that the protective sleeve may be removed prior        to treatment using the lysing tip.    -   222. The system of example 220, wherein the protective sleeve is        made up of a biodegradable material.    -   223. The system of example 161, wherein the lysing tip further        comprises an antenna configured to track a location of the        lysing tip during a surgical procedure.    -   224. The system of example 223, wherein the antenna comprises a        radiofrequency identification tag.    -   225. The system of example 223, wherein the lysing tip further        comprises a sensor, and wherein the sensor is coupled with the        antenna such that location data may be combined with sensor data        from the sensor.    -   226. The system of example 225, wherein the sensor comprises a        temperature sensor.    -   227. The system of example 161, further comprising a canal        configured to selectively deliver fluids adjacent to the lysing        tip during a surgical procedure.    -   228. The system of example 227, wherein the canal is selectively        retractable and advanceable relative to the cannula.    -   229. The system of example 161, wherein the at least one lysing        member comprises a first lysing member and a second lysing        member, and wherein the first lysing member is electrically        isolated from the second lysing member.    -   230. The system of example 229, wherein the lysing tip is        configured to deliver bipolar electrosurgical energy, wherein        the first lysing member comprises a positive lysing member        configured to deliver positive electrosurgical energy, and        wherein the second lysing member comprises a negative lysing        member configured to deliver negative electrosurgical energy.    -   231. The system of example 229, wherein the first lysing member        defines only a first lysing segment of the plurality of lysing        segments, and wherein the second lysing member defines only a        second lysing segment of the plurality of lysing segments.    -   232. The system of example 229, further comprising:        -   a first tunnel formed in at least a first subset of the            plurality of beads; and        -   a second tunnel formed in at least a second subset of the            plurality of beads, wherein the first lysing member extends            through the first tunnel, and wherein the second lysing            member extends through the second tunnel.    -   233. The system of example 232, wherein the first lysing member        comprises a flexible wire and wherein the second lysing member        comprises a flexible wire.    -   234. The system of example 233, further comprising means for        maintaining a flexible lysing member in a rigid state to define        a lysing segment.    -   235. The system of example 234, wherein the means for        maintaining a flexible lysing member in a rigid state to define        a lysing segment comprises at least one of a bead tunnel having        a cross-sectional dimension less than a cross-sectional        dimension of a lysing member extending therethrough and a        plurality of protuberances.    -   236. An electrosurgical system, comprising:        -   a lysing tip comprising a treatment side and an            orientational-deployment side opposite from the treatment            side, wherein the lysing tip comprises an upper side and a            lower side opposite from the upper side, and wherein the            lysing tip further comprises:            -   a plurality of beads;            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads,                wherein the lysing tip comprises a primary axis                extending between a first outer bead of the plurality of                beads and a second outer bead of the plurality of beads,                and wherein each of the plurality of beads comprises a                tip extending at least substantially perpendicular to                the primary axis; and            -   an energy window positioned on at least one of the upper                side and the lower side of the lysing tip, wherein the                energy window is configured to selectively deliver                energy therethrough to treat tissue during a surgical                procedure with the lysing tip; and            -   a cannula configured for delivery of the lysing tip                therethrough into a patient's body, wherein the cannula                comprises a cannula axis, and wherein the system is                configured such that the lysing tip can be delivered                through the cannula in a delivery configuration.    -   237. The system of example 229, wherein the system is configured        such that the lysing tip can be delivered through the cannula in        a delivery configuration with the primary axis aligned with the        cannula axis.    -   238. The system of example 229, wherein the energy window        comprises an energy window array defined by plurality of        electrode termini.    -   239. The system of example 238, wherein each of the plurality of        electrode termini are separated from one another such that the        energy window is configured to treat tissue with the energy        window to result in damaged tissue from the electrode termini        and intermittent islands of undamaged tissue.    -   240. The system of example 229, further comprising a support        member extending between the first outer bead of the plurality        of beads and the second outer bead of the plurality of beads        opposite from the first outer bead on the        orientational-deployment side.    -   241. The system of example 240, further comprising a first        actuation rod and a second actuation rod, wherein the first and        second actuation rods are configured to reorient the lysing tip        between a delivery configuration in which the primary axis        extends through the lumen and a treatment configuration in which        the primary axis extends at least substantially perpendicular to        an axis of the lumen outside of a distal end of the cannula.    -   242. The system of example 241, wherein the first actuation rod        is coupled to the support member adjacent to the first outer        bead, and wherein the second actuation rod is coupled to the        support member adjacent to the second outer bead.    -   243. The system of example 242, wherein the support member is        formed in a bow shape from a first end of the support member to        a second end of the support member opposite from the first end.    -   244. The system of example 243, wherein the support member is        coupled with the at least one lysing member at the first end        second end of the support member and at the second end of the        support member.    -   245. The system of example 229, wherein the energy window        comprises an energy window strip, and wherein the energy window        strip is positioned to extend along respective upper surfaces of        each of the plurality of beads.    -   246. The system of example 240, wherein the energy window strip        comprises a plurality of electrode termini.    -   247. The system of example 246, wherein each of the plurality of        electrode termini protrude from an upper surface of the energy        window strip.    -   248. The system of example 240, further comprising an energy        window cover configured to receive the energy window strip and        couple the energy window strip with each of the plurality of        beads.    -   249. The system of example 248, wherein the energy window cover        comprises an insulation cover made up of a non-conductive        material, and wherein the energy window strip is made up of a        conductive material configured to receive and delivery energy        therethrough.    -   250. The system of example 249, wherein the insulation cover        comprises:        -   an elongated base configured to receive the energy window            strip; and        -   a plurality of bead coupling members, wherein each of the            plurality of bead coupling members is configured to couple            with one of the plurality of beads.    -   251. The system of example 240, wherein the energy window strip        is configured to deliver at least one of LASER, intense pulse        light, resistive heating, radiant heat, ultrasound, and        microwave energy.    -   252. The system of example 240, wherein the energy window strip        is configured to deliver radiofrequency energy.    -   253. The system of example 238, wherein the energy window is        configured to deliver bipolar electrosurgical energy, and        wherein a first subset of the plurality of electrode termini are        electrically isolated from a second subset of the plurality of        electrode termini.    -   254. A method for delivery of an electrosurgical device into a        patient for use during a surgical procedure, the method        comprising the steps of:        -   delivering a lysing tip through a first cannula            subcutaneously into a patient's body, wherein the lysing tip            comprises:            -   a plurality of beads;            -   at least one lysing member defining at least one lysing                segment extending between each pair of adjacent beads;                and            -   a support member coupled with the at least one lysing                member, wherein the support member is configured to                facilitate coupling of the lysing tip to a surgical tool                used to control the lysing tip during a surgical                procedure within the patient's body;        -   advancing the lysing tip beyond a distal opening of the            first cannula;        -   delivering the surgical tool into the patient's body            adjacent to the lysing tip;        -   coupling the lysing tip with the surgical tool; and        -   delivering electrosurgical energy from the surgical tool to            the at least one lysing member.    -   255. The method of example 254, wherein the support member        extends between a first outer bead of the plurality of beads and        a second outer bead of the plurality of beads opposite from the        first outer bead on the orientational-deployment side.    -   256. The method of example 254, wherein the at least a proximal        portion of the support member extends along the        orientational-deployment side of the lysing tip, and wherein the        step of coupling the lysing tip to the surgical tool comprises        coupling the proximal portion of the support member with the        surgical tool.    -   257. The method of example 256, wherein the support member        defines a bow shape, wherein the support member comprises a        grasping pad, wherein the surgical tool comprises at least one        jaw, and wherein the step of coupling the lysing tip to the        surgical tool comprises coupling the grasping pad with the at        least one jaw.    -   258. The method of example 254, further comprising a tunnel        extending at least partially through each of the plurality of        beads, wherein the at least one lysing member is positioned to        extend at least partially through the tunnel to define the at        least one lysing segment between each pair of adjacent beads.    -   259. The method of example 254, wherein the step of delivering        the surgical tool into the patient's body adjacent to the lysing        tip comprises delivering the surgical tool through a second        cannula.    -   260. The method of example 254, further comprising:        -   advancing a second surgical tool into the patient's body;        -   using the second surgical tool to couple the lysing tip with            the first surgical tool;        -   releasing the lysing tip from the second surgical tool; and        -   using the first surgical tool to perform a surgical            procedure with the lysing tip.    -   261. The method of example 254, wherein the lysing tip further        comprises a plurality of spacers, and wherein each of the        plurality of spacers is coupled with a respective lysing segment        of the plurality of lysing segments.    -   262. A lysing tip, comprising:        -   a treatment side and an orientational-deployment side            opposite from the treatment side;        -   a grasping pad on the orientational-deployment side, wherein            the grasping pad is configured to receive and deliver            electrosurgical energy;        -   a plurality of beads;        -   a lysing rod defining a plurality of lysing segments,            wherein each of the plurality of lysing segments extends            between a pair of adjacent beads of the plurality of beads;            and        -   a support member coupled to the lysing rod at opposite ends            of the lysing rod, wherein the support member is configured            to facilitate coupling of the lysing tip to a surgical tool            used to control the lysing tip during a surgical procedure            within a patient's body and deliver electrosurgical energy            through the grasping pad and into the lysing rod.    -   263. The lysing tip of example 262, wherein the grasping pad is        formed on the support member.    -   264. The lysing tip of example 263, wherein the grasping pad        comprises a tab projecting from the support member.    -   265. The lysing tip of example 262, wherein the support member        is coupled to the lysing rod between a first outer bead of the        plurality of beads and a second outer bead of the plurality of        beads opposite from the first outer bead on the        orientational-deployment side.    -   266. The lysing tip of example 265, wherein the support member        is formed in a bow shape from a first end of the support member        coupled with the lysing rod to a second end of the support        member coupled with the lysing rod opposite from the first end.    -   267. The lysing tip of example 262, further comprising a        plurality of spacers, wherein each of the plurality of spacers        is coupled with the lysing rod at a respective lysing segment of        the plurality of lysing segments.    -   268. The lysing tip of example 267, wherein each of the        plurality of spacers is fixedly coupled with the lysing rod.    -   269. The lysing tip of example 267, wherein each of the        plurality of spacers comprises a slot configured to allow each        of the respective spacers to be coupled with the lysing rod by        advancing each of the respective spacers towards the lysing rod        adjacent to the slot in a direction perpendicular to an axis of        the lysing rod.    -   270. The lysing tip of example 267, wherein each of the        plurality of spacers comprises a conductive material such that        electrosurgical energy can be delivered through the spacers from        the lysing rod.    -   271. The lysing tip of example 267, wherein each of the        plurality of spacers is configured to confine at least one        respective bead of the plurality of beads to a predetermined        location on the lysing rod.    -   272. The lysing tip of example 271, wherein each of the        plurality of spacers is configured to restrict an amount of        rotation of at least one respective bead of the plurality of        beads on the lysing rod.    -   273. The lysing tip of example 272, wherein each of the        plurality of spacers comprises opposing beveled edges configured        to selectively restrict rotation of adjacent beads on the lysing        rod.    -   274. The lysing tip of example 271, wherein each of the        plurality of spacers is in direct contact with two respective        beads on opposite ends of the spacer.    -   275. The lysing tip of example 262, further comprising a        plurality of protuberances configured to confine each of the        plurality of beads to a predetermined region relative to the        lysing rod, wherein each of the lysing segments comprises a        first protuberance adjacent a first respective bead and a second        protuberance adjacent a second respective beads.    -   276. The lysing tip of example 273, wherein the plurality of        protuberances are configured to prevent any lateral movement of        the plurality of beads on the lysing rod.    -   277. The lysing tip of example 262, wherein the lysing rod        comprises a hollow rod.    -   278. The lysing tip of example 277, wherein the lysing rod        comprises a first plurality of sections having non-circular        cross-sections.    -   279. The lysing tip of example 278, wherein each of the first        plurality of sections correspond with each of the plurality of        lysing segments.    -   280. The lysing tip of example 278, wherein each of the        plurality of sections is configured to confine each of the        plurality of beads to a predetermined region relative to the        lysing rod.    -   281. The lysing tip of example 278, wherein each of the        plurality of sections comprises a flattened shape.    -   282. The lysing tip of example 281, wherein each of the        plurality of sections comprises a leading edge extending towards        the treatment side.    -   283. The lysing tip of example 278, wherein the lysing rod        further comprises a second plurality of sections having circular        cross-sections.    -   284. The lysing tip of example 283, wherein the second plurality        of sections extend through tunnels extending at least partially        through each of the plurality of beads.    -   285. The lysing tip of example 262, wherein the lysing rod        extends at least partially through each of the plurality of        beads.    -   286. The lysing tip of example 285, wherein the lysing rod        defines a coupling axis with the plurality of beads, wherein        each of the plurality of beads defines a bead axis extending        from a leading end to a trailing end, and wherein the bead axis        of each of the plurality of beads is at least substantially        perpendicular to the coupling axis.    -   287. The lysing tip of example 286, wherein the lysing rod        extends through at least a subset of the plurality of beads at a        non-central location relative to a bead axis of each of the at        least a subset of the plurality of beads.    -   288. The lysing tip of example 287, wherein the lysing rod        extends through each of the plurality of beads at a non-central        location relative to a bead axis of each of the plurality of        beads.    -   289. The lysing tip of example 287, wherein the non-central        location is positioned towards the leading end of each of the at        least a subset of the plurality of beads.    -   290. The lysing tip of example 262, wherein each of the        plurality of beads defines a bead axis extending from a leading        end to a trailing end, wherein the plurality of beads comprises        a first subset of beads having a first length extending along        the bead axis of each of the first subset of beads, wherein the        plurality of beads comprises a second subset of beads having a        second length extending along the bead axis of each of the        second subset of beads, and wherein the first length is greater        than the second length.    -   291. The lysing tip of example 290, wherein the first subset of        beads comprises a first outer bead positioned adjacent to a        first end of the lysing rod and a second outer bead positioned        adjacent to a second end of the lysing rod opposite from the        first end.    -   292. The lysing tip of example 291, wherein each of the second        subset of beads comprises a flattened trailing end, and wherein        the flattened trailing end is positioned adjacent to the support        member so as to accommodate the support member extending        proximally of the trailing ends of each of the second subset of        beads.    -   293. The lysing tip of example 292, wherein the support member        comprises an insulated portion and a conductive portion.    -   294. The lysing tip of example 293, wherein the conductive        portion comprises at least a portion of a grasping pad formed on        the support member.    -   295. The lysing tip of example 294, wherein the conductive        portion comprises an opening formed on the grasping pad.    -   296. The lysing tip of example 262, wherein each of at least a        subset of the plurality of beads is configured so as to allow        for rotation of each respective bead of the at least a subset of        the plurality of beads about the lysing rod.    -   297. The lysing tip of example 296, wherein each of the        plurality of beads is configured so as to allow for rotation of        each respective bead of the plurality of beads about the lysing        rod.    -   298. The lysing tip of example 262, wherein each of at least a        subset of the plurality of beads comprises a trailing end having        a rougher exterior surface that its respective leading end.    -   299. The lysing tip of example 298, wherein the at least a        subset of the plurality of beads comprises a first outer bead        positioned at a first end of the lysing rod and a second outer        bead positioned at a second end of the lysing rod opposite from        the first end.    -   300. The lysing tip of example 299, wherein the first outer bead        is positioned adjacent to a first end of the lysing rod, and        wherein the second outer bead is positioned adjacent to a second        end of the lysing rod opposite from the first end of the lysing        rod.    -   301. The lysing tip of example 262, wherein each of at least a        subset of the plurality of beads comprises a plurality of        faceted surfaces.    -   302. The lysing tip of example 301, wherein each of at least a        subset of the plurality of faceted surfaces is positioned at an        acute angle with respect to one another.    -   303. The lysing tip of example 302, each of at least a subset of        the plurality of beads comprises a first faceted surface on an        upper side of the bead and a second faceted surface on a lower        side of the bead, wherein the first faceted surface and the        second faceted surface defined a wedge shape at a leading end of        the bead.    -   304. The lysing tip of example 262, wherein each of at least a        subset of the plurality of beads is configured to move with        respect to the lysing rod during a surgical procedure.    -   305. The lysing tip of example 304, wherein each of the at least        a subset of the plurality of beads is configured to pivot on the        lysing rod.    -   306. The lysing tip of example 305, wherein each of the at least        a subset of the plurality of beads is configured to pivot on the        lysing rod in at least two separate planes.    -   307. The lysing tip of example 262, wherein at least one of the        plurality of beads comprises a hole separated from the lysing        rod, and wherein the hole is configured to be coupled with means        for maintaining retrievability of a free-floating lysing tip        when the lysing tip is decoupled from a grasping/control        instrument.    -   308. The lysing tip of example 262, wherein the means for        maintaining retrievability of a free-floating lysing tip when        the lysing tip is decoupled from a grasping/control instrument        comprises a cord.    -   309. The lysing tip of example 262, further comprising:        -   a first coupling tip at a first end of the lysing rod; and        -   a second coupling tip at a second end of the lysing rod,            wherein the first coupling tip and the second coupling tip            are configured to secure the lysing rod to two outermost            beads of the plurality of beads.    -   310. The lysing tip of example 309, wherein the first coupling        tip differs from the second coupling tip.    -   311. The lysing tip of example 309, wherein the first coupling        tip comprises a weld defining a cross-sectional dimension        greater in at least one direction that a cross-sectional        dimension of the lysing rod.    -   312. The lysing tip of example 262, wherein the lysing rod        comprises at least one of a non-conductive coating and a        non-conductive cover positioned at opposing ends of the lysing        rod.    -   313. The lysing tip of example 312, further comprising:        -   a first coupling tip at a first end of the lysing rod; and        -   a second coupling tip at a second end of the lysing rod,            wherein the first coupling tip and the second coupling tip            are configured to secure the lysing rod to two outermost            beads of the plurality of beads, and wherein the first            coupling tip and the second coupling tip both comprise at            least one of a non-conductive coating and a non-conductive            cover.    -   314. The lysing tip of example 262, further comprising:        -   a first coupling tip at a first end of the lysing rod; and        -   a second coupling tip at a second end of the lysing rod,            wherein the first coupling tip and the second coupling tip            are configured to secure the lysing rod to two outermost            beads of the plurality of beads, wherein the first coupling            tip is positioned within a first outermost bead of the            plurality of beads, and wherein the second coupling tip is            positioned within a second outermost bead of the plurality            of beads opposite from the first outermost bead.    -   315. The lysing tip of example 314, wherein each of the first        outermost bead and the second outermost bead comprises two        concentric tunnels, and wherein each of the first coupling tip        and the second coupling tip is positioned and configured to        engage a ledge positioned at a transition point between the two        concentric tunnels.    -   316. The lysing tip of example 314, wherein each of the first        outermost bead and the second outermost bead comprises a tunnel        that tapers from a larger dimension to a smaller dimension at an        inner side of the outermost beads, and wherein each of the first        coupling tip and the second coupling tip is configured to engage        a portion of their respective tunnel between the larger        dimension and the smaller dimension.    -   317. The lysing tip of example 262, wherein the grasping pad        comprises a plate having opposing flattened surfaces configured        to engage opposing jaws of the surgical tool.    -   318. The lysing tip of example 262, further comprising a        non-conductive sheath configured to cover at least a portion of        the lysing tip, wherein the non-conductive sheath is configured        to expose the plurality of lysing segments.    -   319. An electrosurgical system, comprising:        -   a lysing tip comprising:            -   a plurality of beads; and            -   a lysing member coupling the plurality of beads                together, wherein the lysing member defines at least one                lysing segment extending between each pair of adjacent                beads of the plurality of beads; and            -   a surgical tool configured to selectively engage the                lysing tip and control the lysing tip during a surgical                procedure, wherein the surgical tool comprises a pair of                jaws configured to engage the lysing tip by grasping the                lysing tip.    -   320. The electrosurgical system of example 319, wherein the        electrosurgical system is configured such that the surgical tool        is configured to selectively engage the lysing tip by grasping        the lysing member.    -   321. The electrosurgical system of example 319, wherein a distal        end of the surgical tool is configured to protrude distally        beyond the lysing member when the lysing tip is engaged with the        pair of jaws.    -   322. The electrosurgical system of example 320, wherein, when        the lysing tip is engaged with the pair of jaws, the plurality        of beads and the distal end of the surgical tool are configured        to facilitate blunt dissection of tissue during a surgical        procedure.    -   323. The electrosurgical system of example 320, wherein the        distal end of the surgical tool is configured to protrude        distally beyond the lysing member when the lysing tip is engaged        with the pair of jaws by a distance at least substantially equal        to a distance with which each of the plurality of beads        protrudes distally from the lysing member.    -   324. The electrosurgical system of example 320, wherein a        portion of the distal end of the surgical tool that protrudes        distally beyond the lysing member when the lysing tip is engaged        with the pair of jaws has a shape that is at least substantially        identical to a shape of a portion of each of the plurality of        beads that protrudes distally beyond the lysing member.    -   325. The electrosurgical system of example 319, wherein the        lysing member comprises a lysing plate.    -   326. The electrosurgical system of example 319, further        comprising a slot defined by at least one of the pair of jaws,        wherein the slot is configured to receive the lysing member.    -   327. The electrosurgical system of example 326, wherein the        lysing member comprises a lysing plate, and wherein the slot has        a size when the pair of jaws is closed that is at least        substantially identical to a size of the lysing plate that is        configured to be received in the slot such that the lysing plate        can be rigidly received within the slot.    -   328. The electrosurgical system of example 319, wherein the        surgical tool is configured to deliver electrosurgical energy to        the lysing member through the pair of jaws when the lysing tip        is coupled with the surgical tool.    -   329. The electrosurgical system of example 319, wherein the        lysing member comprises a lysing rod.    -   330. The electrosurgical system of example 329, wherein the        lysing rod is configured to be received in a slot formed within        at least one jaw of the pair of jaws.    -   331. The electrosurgical system of example 330, wherein an upper        jaw of the pair of jaws comprises an overhang portion that        protrudes distally of a lower jaw of the pair of jaws such that        a distal end of the surgical tool is wholly defined by the upper        jaw.    -   332. The electrosurgical system of example 330, wherein the        lysing rod is configured to be loosely received in the slot such        that the lysing tip is allowed to rotate with respect to the        surgical tool.    -   333. The electrosurgical system of example 329, wherein the        lysing tip is configured to be coupled with the surgical tool        such that, while coupled with the lysing tip, a distal end of        the surgical tool protruding distally beyond the lysing rod, has        a shape that at least substantially mimics the shapes of each of        the plurality of beads.    -   334. The electrosurgical system of example 329, wherein each of        the plurality of beads comprises a hole extending to the lysing        rod.    -   335. The electrosurgical system of example 334, wherein each of        the holes of each of the plurality of beads comprises a        substantially vertical tunnel extending from an upper surface of        each of the plurality of beads to the lysing rod.    -   336. The electrosurgical system of example 334, wherein each of        the holes of each of the plurality of beads comprises a binding        material directly coupling each of the plurality of beads to the        lysing rod.    -   337. The electrosurgical system of example 329, further        comprising a grasping plate coupled with the lysing rod, wherein        the surgical tool is configured to selectively engage the lysing        tip and control the lysing tip during a surgical procedure by        grasping the grasping plate.    -   338. The electrosurgical system of example 337, wherein the        surgical tool comprises an upper jaw and a lower jaw defining a        receiving slot, wherein the lysing plate comprises an upper        surface and a lower surface, and wherein the grasping plate is        configured to be received in the receiving slot such that the        upper surface engages a first inner surface of the upper jaw and        such that the lower surface engages a second inner surface of        the lower jaw.    -   339. The electrosurgical system of example 337, wherein the        lysing rod is coupled to the grasping plate such that the lysing        rod fits within a groove formed in a distal surface of the        grasping plate.    -   340. The electrosurgical system of example 339, wherein the        lysing rod is coupled to the grasping plate by way of a snap-fit        engagement between a central portion of the lysing rod and the        groove.    -   341. The electrosurgical system of example 337, wherein each of        the plurality of beads comprises a trailing end and a leading        end, wherein the trailing end of each of the plurality of beads        comprises a rougher surface than the leading end.    -   342. The electrosurgical system of example 337, wherein each of        the plurality of beads is at least partially rotatable with        respect to the lysing rod.    -   343. The electrosurgical system of example 342, wherein each of        the plurality of beads is at least partially rotatable with        respect to each other bead of the plurality of beads.    -   344. The electrosurgical system of example 337, wherein a first        outer end of the lysing rod terminates within a first outer bead        of the plurality of beads, and wherein a second outer end of the        lysing rod terminates within a second outer bead of the        plurality of beads.    -   345. The electrosurgical system of example 344, wherein the        lysing rod comprises opposing coupling tips positioned on the        first outer end and the second outer end.    -   346. The electrosurgical system of example 345, wherein each of        the first outer bead and the second outer bead comprises an        inner tunnel and an outer tunnel, and wherein the outer tunnel        comprises a larger cross-sectional dimension than the inner        tunnel such that each of the coupling tips is able to fit within        the outer tunnel but unable to fit within the inner tunnel.    -   347. The electrosurgical system of example 337, wherein the        grasping plate comprises at least one of a conductive opening        and a conductive projection, wherein the surgical tool comprises        at least one of a conductive opening and a conductive        projection, and wherein the conductive opening or projection of        the grasping plate is configured to selectively engage the        conductive projection or opening of the surgical tool to allow        for delivery of electrosurgical energy from the surgical tool,        through the grasping plate, and into the lysing rod.    -   348. The electrosurgical system of example 347, wherein the        grasping plate comprises a conductive opening, wherein the        surgical tool comprises a pair of jaws comprising a conductive        projection extending from one of the jaws of the pair of jaws,        and wherein the grasping plate is insulated other than the        conductive opening.    -   349. The electrosurgical system of example 348, wherein the        grasping plate comprises a plurality of conductive openings,        wherein the surgical tool comprises a plurality of conductive        projections extending from one of the jaws, and wherein each of        the plurality of conductive projections is configured to be        received in a respective conductive opening of the plurality of        conductive openings.    -   350. The electrosurgical system of example 319, wherein the        plurality of beads comprises a first outer bead positioned at a        first end of the lysing member and a second outer bead        positioned at a second end of the lysing member opposite from        the first end.    -   351. The electrosurgical system of example 350, wherein the        first outer bead comprises a first rounded outer proximal        corner, and wherein the second outer bead comprises a second        rounded outer proximal corner positioned opposite from the first        rounded outer proximal corner.    -   352. The electrosurgical system of example 351, wherein each of        the first outer bead and the second outer bead comprises a        flattened proximal surface.    -   353. The electrosurgical system of example 352, where each of        the flattened proximal surfaces extends into a rounded o    -   354. The electrosurgical system of example 350, wherein each of        the first outer bead and the second outer bead comprises an        ellipsoidal shape extending from a proximal tip to a distal tip        of each of the first outer bead and the second outer bead.    -   355. The electrosurgical system of example 354, wherein each of        the first outer bead and the second outer bead comprises a hole,        wherein the hole is configured to couple with a safety line that        is configured to extend from the lysing tip within a patient's        body to a location outside of the patient's body during a        surgical procedure.    -   356. The electrosurgical system of example 355, wherein the        safety line comprises at least one of a cord, a suture, and a        hook.    -   357. The electrosurgical system of example 355, wherein the hole        comprises a thru-hole, and wherein the hole is positioned in a        proximal portion of each of the first outer bead and the second        outer bead proximally of the lysing member.    -   358. The electrosurgical system of example 357, wherein the        safety line comprises a loopable element configured to extend        through the hole.    -   359. An electrosurgical system, comprising:        -   a lysing tip comprising:            -   a plurality of beads; and            -   a lysing member coupling the plurality of beads                together, wherein the lysing member defines at least one                lysing segment extending between each pair of adjacent                beads of the plurality of beads; and        -   a surgical tool configured to selectively engage the lysing            tip and deliver electrosurgical energy to the lysing member            during a surgical procedure.    -   360. The electrosurgical system of example 359, wherein the        lysing tip further comprises a shaft extending proximally from        the lysing tip, wherein the shaft is electrically coupled with        the lysing member, and wherein the surgical tool comprises a        conductive slot configured to engage the shaft such that, when        the shaft is engaged with the conductive slot, the surgical tool        is able to deliver electrosurgical energy to the lysing member        through the shaft.    -   361. The electrosurgical system of example 360, wherein the        lysing tip further comprises a support member coupled with the        lysing member.    -   362. The electrosurgical system of example 361, wherein the        shaft is coupled with the support member.    -   363. The electrosurgical system of example 362, wherein the        shaft comprises a conductive inner core, and wherein at least a        portion of the shaft comprises an insulating outer shell.    -   364. The electrosurgical system of example 361, wherein the        support member defines a bow shape, wherein the support member        comprises a first end positioned adjacent to a first outer bead        of the plurality of beads and coupled to the lysing member, and        wherein the support member comprises a second end positioned        adjacent to a second outer bead of the plurality of beads        opposite from the first outer bead and coupled to the lysing        member.    -   365. The electrosurgical system of example 359, further        comprising a tether extending from the lysing tip.    -   366. The electrosurgical system of example 365, wherein the        surgical tool comprises an opening configured to receive the        tether so as to facilitate coupling the lysing tip to the        surgical tool.    -   367. The electrosurgical system of example 366, wherein the        surgical tool comprises at least one jaw configured to receive a        portion of the lysing tip.    -   368. The electrosurgical system of example 367, wherein the        opening is positioned in the at least one jaw.    -   369. The electrosurgical system of example 368, wherein the        lysing tip further comprises a grasping pad configured to be        received in the at least one jaw, wherein the tether extends        from the grasping pad, and wherein the tether is configured to        allow the grasping pad to be pulled into the at least one jaw by        pulling the tether proximally.    -   370. The electrosurgical system of example 359, further        comprising at least one magnet configured to guide the lysing        tip to a coupling region of the surgical tool.    -   371. The electrosurgical system of example 370, wherein the        coupling region comprises a pair of jaws formed on a distal end        of the surgical tool.    -   372. The electrosurgical system of example 371, wherein the at        least one magnet is positioned on at least one jaw of the pair        of jaws.    -   373. The electrosurgical system of example 371, wherein the        lysing tip further comprises a grasping pad configured to be        received in the pair of jaws to couple the lysing tip with the        surgical tool, and wherein the at least one magnet comprises a        first magnet positioned on the grasping pad and a second magnet        positioned on at least one jaw of the pair of jaws.    -   374. The electrosurgical system of example 359, wherein the        surgical tool comprises at least one of an opening and a        projection, wherein the lysing tip comprises at least one of a        projection and an opening configured to mate with the at least        one of an opening and a projection of the surgical tool to lock        the lysing tip in place on the surgical tool during a surgical        procedure.    -   375. The electrosurgical system of example 374, wherein the        surgical tool comprises an upper jaw and a lower jaw, wherein        the at least one of an opening and a projection extends from at        least one of the upper jaw and the lower jaw, and wherein the        lysing tip is configured to be received and engaged in between        the upper jaw and the lower jaw during a surgical procedure.    -   376. The electrosurgical system of example 375, wherein the        lysing tip comprises a support member extending adjacent to and        proximal of the plurality of beads, and wherein the at least one        of a projection and an opening of the lysing tip is formed on        the support member.    -   377. The electrosurgical system of example 376, wherein the        lysing tip comprises a first projection extending from an upper        surface of the support member and a second projection extending        from a lower surface of the support member, wherein the upper        jaw comprises a first opening configured to receive the first        projection, and wherein the lower jaw comprises a second opening        configured to receive the second projection.    -   378. The electrosurgical system of example 377, wherein at least        one of the first projection and the second projection is        configured lock the lysing tip in place relative to the surgical        tool at a preconfigured rotational orientation.    -   379. The electrosurgical system of example 378, wherein the at        least one of the first projection and the second projection        comprises a faceted surface, and wherein the surgical tool        comprises an opening comprising a shape configured to mate with        the faceted surface.    -   380. The electrosurgical system of example 378, wherein the at        least one of the first projection and the second projection is        configured to allow for locking the lysing tip in place relative        to the surgical tool at any of a plurality of preconfigured        rotational orientations.    -   381. The electrosurgical system of example 378, wherein the        first projection is configured to lock the lysing tip in place        relative to the surgical tool at a preconfigured rotational        orientation, and wherein the second projection is configured to        be received in the second opening so as to allow the lysing tip        to rotate with respect to the surgical tool while the lysing tip        is coupled with the surgical tool.    -   382. The electrosurgical system of example 381, wherein the        upper jaw is configured to move with respect to the lower jaw        such that the lysing tip can be rotated while the second        projection is received within the second opening and the first        projection is withdrawn from the first opening and then the        upper jaw closed to insert the first projection into the first        opening and lock the lysing tip at a particular rotational        orientation.    -   383. A lysing tip, comprising:        -   a plurality of beads comprising a first outer bead and a            second outer bead opposite from the first outer bead; and        -   a lysing rod extending along a treatment side of the lysing            tip and extending at least partially through each of the            plurality of beads to couple the plurality of beads to one            another, wherein the lysing rod defines at least one lysing            segment extending between each pair of adjacent beads of the            plurality of beads, and wherein the lysing rod is configured            such that a central portion of the lysing rod protrudes            further distally from the treatment side than opposing            portions of the lysing rod immediately adjacent to the first            outer bead and the second outer bead.    -   384. The lysing tip of example 383, wherein the lysing rod        extends in a bowed shape along the treatment side of the lysing        tip.    -   385. The lysing tip of example 384, wherein the plurality of        beads further comprises at least one middle bead positioned        between the first outer bead and the second outer bead, and        wherein the at least one middle bead protrudes distally from the        treatment side to a greater extent than either the first outer        bead or the second outer bead.    -   386. The lysing tip of example 384, further comprising a support        member extending along a side of the lysing tip opposite from        the treatment side, wherein the support member is configured to        facilitate coupling of the lysing tip to a surgical tool used to        control the lysing tip during a surgical procedure within a        patient's body.    -   387. The lysing tip of example 386, wherein the support member        extends in a bowed shape along the side of the lysing tip        opposite from the treatment side, and wherein the bowed shape of        the support member extends in an opposite direction relative to        the bowed shape of the lysing rod.    -   388. The lysing tip of example 387, wherein the support member        further comprises a tongue coupled with at least one central        lysing segment of the lysing rod, wherein the tongue is        configured to maintain the central portion of the lysing rod in        a position protruding further distally from the treatment side        than opposing portions of the lysing rod.    -   389. The lysing tip of example 388, wherein the tongue is        coupled with a single lysing segment of the lysing rod.    -   390. The lysing tip of example 388, further comprising a groove        formed in the tongue, wherein the at least one central lysing        segment is positioned within the groove.    -   391. The lysing tip of example 388, wherein the tongue is        positioned in contact with two beads on opposing sides of the        tongue such that the tongue defines a length of a center lysing        segment of the plurality of lysing segments.    -   392. The lysing tip of example 391, further comprising a        plurality of spacers positioned on the lysing rod so as to        confine each of the plurality of beads to predetermined        locations on the lysing rod.    -   393. The lysing tip of example 392, wherein the center lysing        segment lacks a spacer, and wherein each of the lysing segments        other than the center lysing segment comprises a spacer        positioned thereon.    -   394. A lysing tip, comprising:        -   a plurality of beads;        -   at least one lysing rod defining at least one lysing segment            extending between each pair of adjacent beads;        -   a tunnel extending at least partially through each of the            plurality of beads, wherein the at least one lysing member            is positioned to extend at least partially through the            tunnel to define the at least one lysing segment between            each pair of adjacent beads; and        -   a plurality of sleeves positioned on the at least one lysing            rod, wherein each of the plurality of sleeves is positioned            within a bead of the plurality of beads in between the bead            and the at least one lysing rod.    -   395. The lysing tip of example 394, wherein the plurality of        sleeves comprises:        -   a pair of outer bead sleeves positioned within two opposing            outer beads of the plurality of beads; and        -   at least one inner bead sleeve positioned within at least            one inner bead positioned between the two opposing outer            beads, wherein the pair of outer bead sleeves differs in            structure from the at least one inner bead sleeve.    -   396. The lysing tip of example 394, wherein each of the        plurality of sleeves comprises a material configured to at least        partially insulate each of the plurality of beads from heat from        the at least one lysing rod.    -   397. The lysing tip of example 396, wherein each of the        plurality of sleeves comprises at least one of a ceramic        material and a high-temperature thermoplastic.    -   398. The lysing tip of example 397, wherein each of the        plurality of sleeves comprises at least one of an alumina, a        carbide, a nitride, quartz silica, a silicate, an yttria, a        zirconia, a thermoset plastic, and a high-performance        thermoplastic.    -   399. The lysing tip of example 394, wherein at least a subset of        the plurality of sleeves is configured to rotate about the at        least one lysing rod such that beads coupled with each of the at        least a subset of the plurality of sleeves can rotate on its        respective sleeve with respect to the at least one lysing rod.    -   400. The lysing tip of example 399, wherein each of the        plurality of sleeves is configured to allow each of the        plurality of beads to rotate about the at least one lysing rod,        and wherein each of the plurality of beads is configured to        pivot with respect to the at least one lysing rod as it passes        through tissue during a surgical procedure.    -   401. The lysing tip of example 394, wherein each of the        plurality of sleeves comprises a raised band, and wherein each        of the raised bands is configured to prevent one of the beads        from moving laterally along the at least one lysing rod.    -   402. The lysing tip of example 401, wherein the plurality of        sleeves comprises:        -   a pair of outer bead sleeves positioned within two opposing            outer beads of the plurality of beads, wherein each of the            pair of outer bead sleeves comprises a raised band formed on            an outer edge of the outer bead sleeve; and        -   at least one inner bead sleeve positioned within at least            one inner bead positioned between the two opposing outer            beads, wherein each of the at least one inner bead sleeve            comprises a raised band spaced apart from two opposing ends            of each of the at least one inner bead sleeve.    -   403. The lysing tip of example 401, wherein the plurality of        sleeves comprises a pair of outer bead sleeves positioned within        two opposing outer beads of the plurality of beads, and wherein        each of the pair of outer bead sleeves comprises an inner tunnel        comprising an internal ledge at a transition between a smaller        diameter portion of the inner tunnel and a larger diameter        portion of the inner tunnel.    -   404. The lysing tip of example 394, further comprising a        plurality of protuberances positioned on the at least one lysing        rod, wherein each of at least a subset of the plurality of        sleeves comprises a first protuberance positioned adjacent a        first end of the sleeve and a second protuberance positioned        adjacent a second end of the sleeve opposite from the first end        so as to confine the sleeve to a predetermined location on the        at least one lysing rod.    -   405. The lysing tip of example 394, further comprising at least        one spacer positioned in between at least two adjacent beads of        the plurality of beads, wherein the at least one spacer is        configured to confine at least one sleeve of the plurality of        sleeves to a predetermined location on the at least one lysing        rod.    -   406. The lysing tip of example 394, wherein the at least one        lysing rod comprises at least one hollow lysing rod.    -   407. The lysing tip of example 406, wherein the at least one        hollow lysing rod comprises at least one flattened section        extending between at least two adjacent beads of the plurality        of beads.    -   408. The lysing tip of example 407, wherein the at least one        flattened section comprises a leading distal edge extending at        least substantially towards a treatment side of the lysing tip.    -   409. The lysing tip of example 394, wherein the plurality of        sleeves comprises a pair of outer bead sleeves positioned within        two opposing outer beads of the plurality of beads, wherein each        of the pair of outer bead sleeves comprises an inner tunnel        configured to receive the at least one lysing rod, and wherein        the inner tunnel of each of the outer bead sleeves comprises a        taper from a larger diameter to a smaller diameter.    -   410. The lysing tip of example 409, wherein coupling tips are        formed on opposing ends of the at least one lysing rod, and        wherein the taper of each of the inner tunnels of the outer bead        sleeves is configured to engage one of the coupling tips.    -   411. The lysing tip of example 394, wherein the at least one        lysing rod extends along a treatment side of the lysing tip, and        wherein the lysing tip further comprises a support member        extending along a side of the lysing tip opposite from the        treatment side.    -   412. The lysing tip of example 411, wherein the support member        defines a bow shape, and wherein the support member is coupled        at opposite ends of the support member to the at least one        lysing rod.    -   413. The lysing tip of example 412, wherein the at least one        lysing rod extends through openings in the support member formed        at the opposite ends of the support member.    -   414. The lysing tip of example 394, wherein at least one of the        plurality of beads comprises at least one facet comprising a        flattened region formed on the at least one of the plurality of        beads.    -   415. The lysing tip of example 394, further comprising a support        member extending along a side of the lysing tip opposite from        the treatment side, wherein the support member extends        proximally behind each of a plurality of middle beads positioned        between two opposing outer beads positioned at opposite ends of        the at least one lysing rod.    -   416. The lysing tip of example 415, wherein the lysing tip is        configured to perform in a relaxed configuration in which each        of the middle beads does not contact the support member and a        flexed configuration in which at least one of the middle beads        contacts the support member.    -   417. The lysing tip of example 415, wherein at least a subset of        the plurality of beads is configured to rotate about the at        least one lysing rod, wherein the lysing tip is configured such        that each of the middle beads does not contact the support        member in a relaxed configuration, and wherein the lysing tip is        configured such that at least one of the middle beads contacts        the support member following sufficient rotation of the at least        one of the middle beads about the at least one lysing rod so as        to prevent further rotation.    -   418. The lysing tip of example 394, wherein each of the        plurality of beads comprises at least one of a plastic, a        gelatin, and a hydrogel material.    -   419. The lysing tip of example 418, wherein each of the        plurality of beads is overmolded onto one of the plurality of        sleeves.    -   420. The lysing tip of example 394, wherein each of at least a        subset of the plurality of beads comprises an at least        substantially annular bead structure.    -   421. The lysing tip of example 420, wherein each of the at least        a subset comprises an annular bead structure having at least one        of a circular shape and an oval shape in cross-section.    -   422. The lysing tip of example 420, wherein the plurality of        beads comprises a first outer bead, a second outer bead        positioned opposite from the first outer bead, and at least one        middle bead positioned in between the first outer bead and the        second outer bead, wherein the at least one middle bead defines        a partial annular shape.    -   423. The lysing tip of example 422, wherein the at least one        middle bead comprises opposite ends each terminating in a knob        at a proximal side of the at least one middle bead.    -   424. The lysing tip of example 420, wherein each of the at least        a subset comprises a bead hub positioned within the annular bead        structure, and wherein each of the bead hubs is configured to        couple the annular bead structure with one of the plurality of        sleeves.    -   425. The lysing tip of example 424, wherein each of the at least        a subset further comprises at least one spoke extending from the        bead hub to the annular bead structure.    -   426. The lysing tip of example 424, wherein each of the at least        a subset further comprises a bead hub frame extending        continuously from the bead hub to the annular bead structure        without protruding laterally beyond an upper profile of the        annular bead structure.    -   427. The lysing tip of example 420, wherein the at least one        lysing rod comprises a plurality of deformed regions        corresponding with the plurality of sleeves so as to prevent        each of the plurality of sleeves from being removed from a        predefined region on the at least one lysing rod.    -   428. The lysing tip of example 420, wherein the plurality of        beads comprises a first outer bead, a second outer bead        positioned opposite from the first outer bead, and at least one        middle bead positioned in between the first outer bead and the        second outer bead, wherein each of the first outer bead and the        second outer bead defines a full annular structure extending in        a full perimeter about a respective sleeve of the plurality of        sleeves, and wherein the at least one middle bead defines a        partial annular structure extending in a partial perimeter about        a respective sleeve the plurality of sleeves.    -   429. The lysing tip of example 428, wherein each of the at least        one middle bead comprises knobs formed at opposing ends of the        partial annular structure.    -   430. The lysing tip of example 428, wherein the at least one        lysing rod extends along a treatment side of the lysing tip,        wherein the lysing tip further comprises a support member        extending along a side of the lysing tip opposite from the        treatment side, and wherein the at least one middle bead is        configured to operate in a relaxed configuration in which the at        least one middle bead is spaced apart from the support member, a        first flexed configuration in which the at least one middle bead        rotates about the lysing rod in a first direction and a first        terminal end of the at least one middle bead contacts the        support member to inhibit further rotation in the first        direction, and a second flexed configuration in which the at        least one middle bead rotates about the lysing rod in a second        direction and a second terminal end of the at least one middle        bead opposite from the first terminal end contacts the support        member to inhibit further rotation in the second direction.    -   431. The lysing tip of example 420, wherein the plurality of        beads comprises a first outer bead, a second outer bead        positioned opposite from the first outer bead, and at least one        middle bead positioned in between the first outer bead and the        second outer bead, wherein each of the plurality of beads        defines a full annular structure extending in a full perimeter        about a respective sleeve of the plurality of sleeves.    -   432. The lysing tip of example 431, wherein each of the at least        one middle bead comprises a full annular structure comprising a        rounded leading end and a flattened trailing end.    -   433. The lysing tip of example 432, wherein the first outer bead        and the second outer bead comprise a rounded leading end and a        rounded trailing end.    -   434. The lysing tip of example 431, wherein each of the at least        a subset comprises a bead hub positioned within the annular bead        structure, wherein each of the bead hubs is configured to couple        the annular bead structure with one of the plurality of sleeves,        and wherein the first outer bead and the second outer bead are        coupled directly to an interior surface of the full annular        structure.    -   435. The lysing tip of example 420, wherein each of the        plurality of beads comprises an annular structure, and wherein        the annular structure comprises an annular band structure.    -   436. The lysing tip of example 435, wherein the annular band        structure is defined by an upper surface extending in a full        perimeter about the annular band structure, wherein the annular        band structure is further defined by a lower surface extending        in a full perimeter about the annular band structure, and        wherein the upper surface is at least substantially parallel to        the lower surface about the full perimeter.    -   437. The lysing tip of example 435, wherein the annular band        structure comprises a resiliently flexible material such that        the annular band structure can deform during a surgical        procedure and automatically return to a relaxed configuration.    -   438. The lysing tip of example 437, wherein each of the        plurality of beads comprises a bead hub positioned within the        annular band structure, wherein each of the bead hubs is        configured to couple the annular band structure with one of the        plurality of sleeves.    -   439. The lysing tip of example 438, wherein each of the        plurality of beads further comprises at least two spokes        extending between the bead hub and the annular band structure.    -   440. The lysing tip of example 439, wherein the at least two        spokes comprises only a first spoke extending between an upper        portion of the annular band structure and a second spoke        extending between a lower portion of the annular band structure,        and wherein the first spoke and the second spoke are positioned        and configured to allow the annular band structure to compress        during a surgical procedure.    -   441. The lysing tip of example 440, wherein the first spoke and        the second spoke are positioned and configured to allow the        annular band structure to compress between an upper portion and        a lower portion of the annular band structure and to compress        between a distal portion and a proximal portion of the annular        band structure.    -   442. The lysing tip of example 437, wherein the annular band        structure is configured to compress during a surgical procedure        to reduce a cross-sectional profile of the annular band        structure between an upper end of the annular band structure and        a lower end of the annular band structure.    -   443. The lysing tip of example 442, wherein the annular band        structure is further configured such that, upon encountering        sufficiently dense tissue at a distal tip of the annular band        structure, the at least one lysing rod advances in a distal        direction relative to the annular band structure.    -   444. The lysing tip of example 442, wherein the annular band        structure is configured to elongate between a distal end and a        proximal end of the annular band structure as the annular band        structure compresses to reduce the cross-sectional profile.    -   445. A system comprising the lysing tip of example 394, wherein        the system further comprises:        -   a cannula configured to deliver the lysing tip therethrough;            and        -   a deployment assembly configured to reposition the lysing            tip from a delivery configuration and a treatment            configuration.    -   446. The system of example 445, wherein the deployment assembly        comprises a pair of actuation rods coupled to the lysing tip,        wherein the pair of actuation rods is configured to pivot the        lysing tip between the delivery and treatment configurations.    -   447. The system of example 446, wherein, in the delivery        configuration, an axis of the at least one lysing rod extends        along an axis of the cannula, and wherein, in the treatment        configuration, the axis of the at least one lysing rod extends        at least substantially perpendicular to the axis of the cannula        outside of a distal opening of the cannula.    -   448. A system for delivery of tissue modification energy during        a surgical procedure, the system comprising:        -   a tissue modification tip comprising an energy window            configured to deliver energy therethrough for modification            of patient tissue during a surgical procedure;        -   at least one cannula configured to deliver the tissue            modification tip therethrough; and        -   a deployment assembly comprising at least one actuation rod,            wherein the at least one actuation rod is configured to            pivot the tissue modification tip between a delivery            configuration in which an axis of the energy window extends            along an axis of the cannula and a treatment configuration            in which the axis of the energy window extends at least            substantially perpendicular to the axis of the cannula            outside a distal opening of the at least one cannula.    -   449. The system of example 448, wherein the at least one cannula        comprises an inner cannula and an outer cannula.    -   450. The system of example 449, wherein the tissue modification        tip is configured to be fully received within the outer cannula        in the delivery configuration, and wherein the tissue        modification tip is configured to be unable to be fully received        within the inner cannula in the delivery configuration.    -   451. The system of example 448, wherein the energy window        comprises an energy window array comprising a plurality of        isolated energy window termini.    -   452. The system of example 451, wherein the energy window is        configured to deliver electrosurgical energy through each of the        plurality of isolated energy window termini.    -   453. The system of example 452, wherein the energy window is        configured to deliver coagulation electrosurgical energy through        each of the plurality of isolated energy window termini.    -   454. The system of example 451, wherein the energy window is        configured to deliver pulsed electrosurgical energy through each        of the plurality of isolated energy window termini.    -   455. The system of example 454, wherein the pulsed        electrosurgical energy is configured such that, upon moving the        tissue modification tip through a patient's tissue, intermittent        islands of unmodified tissue are created in between tissue        modified by the energy window.    -   456. The system of example 451, wherein at least a first subset        of the plurality of isolated energy window termini is both        physically and electrically isolated from at least a second        subset of the plurality of isolated energy window termini.    -   457. The system of example 456, wherein each of the first subset        of the plurality of isolated energy window termini is configured        to deliver a first modality of energy, and wherein the second        subset of the plurality of isolated energy window termini is        configured to deliver a second modality of energy that differs        from the first modality.    -   458. The system of example 457, wherein the first modality        comprises an electrosurgical energy of a first frequency, and        wherein the second modality comprises an electrosurgical energy        of a second frequency distinct from the first frequency.    -   459. The system of example 448, wherein the at least one        actuation rod comprises:        -   a central actuation rod coupled to a central portion of the            tissue modification tip; and        -   a side actuation rod coupled at a first end of the side            actuation rod to the tissue modification tip adjacent a            first end of the tissue modification tip and coupled to the            central actuation rod at a second end of the side actuation            rod opposite from the first end of the side actuation rod.    -   460. The system of example 448, further comprising at least one        canal configured to extend through the at least one cannula to        deliver fluid to a surgical site adjacent to the tissue        modification tip during a surgical procedure.    -   461. A system for delivery of tissue modification energy during        a surgical procedure, the system comprising:        -   a tissue modification tip comprising an energy window            configured to deliver energy therethrough for modification            of patient tissue during a surgical procedure;        -   a grasping pad; and        -   a first instrument configured to selectively couple with the            tissue modification tip, wherein the first instrument is            configured to selectively couple with the tissue            modification tip at the grasping pad.    -   462. The system of example 461, wherein the energy window        comprises an elongated energy window extending along an upper        surface of the tissue modification tip.    -   463. The system of example 462, wherein the tissue modification        tip comprises a plurality of bars extending across the elongated        energy window, and wherein the plurality of bars is configured        to separate the elongated energy window into a plurality of        isolated energy windows.    -   464. The system of example 463, wherein the elongated energy        window comprises a primary axis extending from a first side of        the elongated energy window to a second side of the elongated        energy window opposite from the first side, and wherein each of        the plurality of bars extends across the elongated energy window        in a direction at least substantially perpendicular to the        primary axis.    -   465. The system of example 461, wherein the energy window        comprises a plurality of isolated energy window termini formed        on an upper surface of the tissue modification tip.    -   466. The system of example 461, wherein the grasping pad is        electrically coupled with the energy window, and wherein the        first instrument is configured to deliver energy to the energy        window through the grasping pad while the tissue modification        tip is coupled with the first instrument.    -   467. The system of example 461, further comprising an energy        conduit coupled with the energy window.    -   468. The system of example 467, wherein the energy conduit        comprises a wire extending from the energy window and configured        to extend through a lumen formed in the first instrument.    -   469. The system of example 461, wherein the energy window is        configured to deliver at least one of LASER, intense pulse        light, resistant heating, radiant heat, thermochromic,        ultrasound, and microwave energy.    -   470. The system of example 461, wherein the tissue modification        tip further comprises at least one of an energy window tongue        and an energy window slot configured to couple with a        corresponding slot or tongue of the first instrument, and        wherein the at least one of an energy window tongue and an        energy window slot is configured to deliver energy therethrough        to the energy window from the first instrument.    -   471. The system of example 470, wherein the tissue modification        tip comprises an energy window tongue formed on the grasping        pad, wherein the first instrument comprises a pair of jaws        configured to grasp the grasping pad, wherein the first        instrument comprises an energy window slot configured to receive        the energy window tongue, and wherein the energy window slot is        formed on at least one of the pair of jaws.    -   472. An electrosurgical system, comprising:        -   a lysing tip configured for delivery of electrosurgical            energy, wherein the lysing tip comprises:            -   a first lysing tip portion comprising an energy delivery                side configured to receive and deliver electrosurgical                energy for one or more of tissue dissection and                modification and an orientational-deployment side                opposite from the energy delivery side;            -   a second lysing tip portion pivotably coupled with the                first lysing tip portion and comprising an energy                delivery side configured to receive and deliver                electrosurgical energy for one or more of tissue                dissection and modification and an                orientational-deployment side opposite from the energy                delivery side, wherein the lysing tip is configured to                be repositioned between a delivery configuration in                which the energy delivery side of the first lysing tip                portion is positioned adjacent to the energy delivery                side of the second lysing tip portion and a treatment                configuration in which the energy delivery side of the                first lysing tip portion and the energy delivery side of                the second lysing tip portion collectively define an                energy delivery side of the lysing tip; and        -   a deployment assembly coupled with the lysing tip, wherein            the deployment assembly is configured to allow for selective            repositioning between the delivery configuration and the            treatment configuration.    -   473. The system of example 472, wherein each of the first tip        portion and the second tip portion comprises a plurality of        protrusions and at least one recession positioned between at        least two adjacent protrusions in the plurality of protrusions.    -   474. The system of example 473, wherein the lysing tip comprises        at least one lysing member forming a lysing segment between each        two adjacent protrusions.    -   475. The system of example 473, wherein the lysing tip is        configured such that at least a subset of the plurality of        protrusions of the first tip portion nests within at least a        subset of the at least one recession of the second tip portion        in the delivery configuration.    -   476. The system of example 472, wherein the first tip portion is        configured to extend at least substantially parallel to the        second tip portion in the delivery configuration.    -   477. The system of example 472, wherein the first tip portion is        configured to extend adjacent to the second tip portion in the        treatment configuration such that the orientational-deployment        side of the first tip portion extends at least substantially        co-planar relative to the orientational-deployment side of the        second tip portion.    -   478. The system of example 472, wherein the lysing tip is        configured such that the first tip portion may be approximated        with the second tip portion during a surgical procedure to clamp        patient tissue therebetween.    -   479. The system of example 472, wherein the lysing tip is        configured to operate in an intermediate configuration between        the treatment configuration and the delivery configuration,        wherein, in the intermediate configuration, the        orientational-deployment sides of the first and second tip        portions extend at an acute angle relative to one another, and        wherein the lysing tip is configured to deliver electrosurgical        energy to both the first and second tip portions in the        intermediate configuration.    -   480. The system of example 472, wherein the first tip portion        comprises at least one lysing segment configured to deliver        electrosurgical energy therethrough, wherein the second tip        portion comprises at least one lysing segment configured to        deliver electrosurgical energy therethrough, and wherein the at        least one lysing segment of the first tip portion is        electrically isolated from the at least one lysing segment of        the second tip portion.    -   481. The system of example 480, wherein the lysing tip comprises        a bipolar lysing tip.    -   482. The system of example 472, wherein the lysing tip comprises        a bipolar lysing tip, wherein the first tip portion comprises at        least one lysing segment configured to deliver electrosurgical        energy therethrough, wherein the second tip portion comprises at        least one lysing segment configured to deliver electrosurgical        energy therethrough, and wherein the lysing tip is configured        such that, in the treatment configuration, each lysing segment        of the first and second tip portions is configured to deliver        electrosurgical energy of an opposite polarity relative to each        adjacent lysing segment of the first and second tip portions.    -   483. A method for electrosurgically treating patient tissue, the        method comprising the steps of:        -   delivering a lysing tip through a first cannula in a            delivery configuration, wherein the lysing tip comprises:            -   a first lysing tip portion comprising an energy delivery                side configured to receive and deliver electrosurgical                energy for one or both of tissue dissection and                modification and an orientational-deployment side                opposite from the energy delivery side;            -   a second lysing tip portion pivotably coupled with the                first lysing tip portion and comprising an energy                delivery side configured to receive and deliver                electrosurgical energy for tissue dissection and/or                modification and an orientational-deployment side                opposite from the energy delivery side, wherein at least                one of the energy delivery side and the                orientational-deployment side of both the first lysing                tip portion and the second lysing tip portion faces an                inner wall of the cannula in the delivery configuration;        -   reconfiguring the lysing tip to a treatment configuration by            pivoting the first lysing tip portion relative to the second            lysing tip portion; and        -   delivering electrosurgical energy to the first and second            lysing tip portions to treat patient tissue.    -   484. The method of example 483, wherein the lysing tip is        configured in the delivery configuration such that the energy        delivery side of the first lysing tip portion faces the energy        delivery side of the second lysing tip portion.    -   485. The method of example 484, wherein the step of        reconfiguring the lysing tip to a treatment configuration        comprises pivoting the first lysing tip portion relative to the        second lysing tip portion such that the first lysing tip portion        extends at an acute angle relative to the second lysing tip        portion.    -   486. The method of example 485, further comprising:        -   positioning at least one of a duct and a blood vessel of a            patient in between the first lysing tip portion and the            second lysing tip portion; and        -   approximating the first and second lysing tip portions to            clamp the at least one of a duct and a blood vessel            therebetween.    -   487. The method of example 484, wherein the step of        reconfiguring the lysing tip to a treatment configuration        comprises pivoting the first lysing tip portion relative to the        second lysing tip portion such that the first lysing tip portion        is aligned with the second lysing tip portion and such that the        energy delivery sides of the first and second lysing tip        portions extend in at least substantially the same direction.    -   488. The method of example 484, wherein the step of        reconfiguring the lysing tip to a treatment configuration        comprises pivoting the first lysing tip portion relative to the        second lysing tip portion such that the first lysing tip portion        and the second lysing tip portion are at least substantially        perpendicular to an axis of the first cannula.    -   489. The method of example 488, wherein, in the treatment        configuration, at least one of the first and second lysing tip        portions extend beyond a cross-sectional profile of the first        cannula.    -   490. The method of example 489, wherein, in the treatment        configuration, both the first and second lysing tip portions        extend beyond the cross-sectional profile of the first cannula.    -   491. A method for performing an electrosurgical procedure, the        method comprising the steps of:        -   delivering a lysing tip through an entrance incision into a            patient's body in a delivery configuration, wherein the            lysing tip comprises:            -   a plurality of protrusions; and            -   at least one lysing segment positioned between at least                two adjacent protrusions in the plurality of                protrusions;        -   reconfiguring the lysing tip to a treatment configuration;            and        -   passing the lysing tip to a target tissue area within the            patient's body.    -   492. The method of example 491, wherein the step of delivering a        lysing tip through an entrance incision into a patient's body in        a delivery configuration comprises delivering the lysing tip        through a first cannula into the patient's body in the delivery        configuration.    -   493. The method of example 492, wherein the lysing tip extends        at least substantially along an axis of the first cannula in the        delivery configuration, and wherein the step of reconfiguring        the lysing tip to a treatment configuration comprises pivoting        the lysing tip outside of a distal end of the first cannula such        that at least one end of two opposing ends of the lysing tip        extends beyond a cross-sectional profile of the first cannula.    -   494. The method of example 491, further comprising setting a        threshold temperature for operation of the lysing tip.    -   495. The method of example 494, wherein the threshold        temperature comprises at least one of a threshold temperature of        patient tissue and a threshold temperature of at least a portion        of the lysing tip.    -   496. The method of example 491, further comprising setting an        energy level for delivery of electrosurgical energy to the        lysing tip.    -   497. The method of example 491, wherein the step of delivering        the lysing tip comprises inserting the lysing tip through the        entrance incision through a first cannula and releasing the        lysing tip, and wherein the step of reconfiguring the lysing tip        to a treatment configuration comprises delivering a        grasping/control instrument into the patient's body adjacent to        the lysing tip and coupling the lysing tip with the        grasping/control instrument.    -   498. The method of example 491, further comprising delivering        electrosurgical energy to the at least one lysing segment.    -   499. The method of example 491, further comprising:        -   obtaining sensor data;        -   comparing the sensor data with a threshold; and        -   upon detecting that a parameter of the sensor data has            exceeded the threshold, reducing energy delivered to the            lysing tip.    -   500. The method of example 499, wherein the sensor data        comprises temperature data, and wherein the threshold comprises        a temperature threshold.    -   501. The method of example 491, further comprising receiving        location data associated with the lysing tip during a surgical        procedure.    -   502. The method of example 501, wherein the step of receiving        location data comprises receiving RFID tag data from an RFID tag        located on the lysing tip.    -   503. The method of example 501, further comprising receiving        temperature data from a temperature sensor on the lysing tip.    -   504. The method of example 503, further comprising combining the        temperature data and the location data.    -   505. The method of example 504, further comprising creating an        image using both the temperature data and the location data.    -   506. The method of example 505, wherein the image allows a user        to determine which regions within a patient's body have been        adequately treated using the lysing tip.    -   507. The method of example 505, wherein the image allows a user        to determine which regions within a patient's body have exceeded        a threshold temperature resulting from use of the lysing tip.    -   508. The method of example 491, wherein the entrance incision        comprises a first length, wherein the lysing tip comprises a        greatest dimension, and wherein the first length is less than        the greatest dimension of the lysing tip.    -   509. The method of example 508, wherein the greatest dimension        of the lysing tip is defined between a first outer protrusion of        the plurality of protrusions and a second outer protrusion of        the plurality of protrusions opposite from the first outer        protrusion.    -   510. The method of example 509, wherein the step of delivering        the lysing tip comprises inserting the lysing tip through the        entrance incision through a first cannula in the delivery        configuration and extending the lysing tip through a distal        opening of the first cannula, and wherein the step of        reconfiguring the lysing tip to the treatment configuration        comprises rotating the lysing tip within the patient's body such        that the greatest dimension is greater than a cross-sectional        diameter of the first cannula and such that the lysing tip        cannot be received back into the first cannula in the treatment        configuration.    -   511. The method of example 510, wherein the step of delivering        the lysing tip comprises inserting the lysing tip through the        entrance incision through a first cannula extending over a        second cannula.    -   512. The method of example 511, wherein the lysing tip is        configured such that it may not be received within the second        cannula in the delivery configuration.    -   513. The method of example 491, further comprising creating a        path to a target organ using the lysing tip.    -   514. The method of example 513, wherein the step of creating a        path to the target organ comprises activating an electrosurgical        generator and delivering electrosurgical energy from the        electrosurgical generator to the at least one lysing segment.    -   515. The method of example 513, further comprising identifying        critical tissue that is not to be treated using the lysing tip,        and wherein the step of creating the path to the target organ        comprises creating a path to the target organ that avoids the        critical tissue.    -   516. The method of example 513, further comprising expanding the        path to the target organ using the lysing tip.    -   517. The method of example 516, wherein the plurality of        protrusions comprises a first outer protrusion and a second        outer protrusion opposite from the first outer protrusion,        wherein the first outer protrusion extends in a first direction,        wherein the second outer protrusion extends in a second        direction, and wherein the first direction extends at an angle        relative to the second direction.    -   518. The method of example 517, wherein the step of expanding        the path to the target organ comprises using a side-to-side        fanning motion to expand the path.    -   519. The method of example 491, further comprising:        -   creating a path to a target organ using the lysing tip;        -   reconfiguring the lysing tip from the treatment            configuration to the delivery configuration;        -   withdrawing the lysing tip from the patient's body through            the entrance incision;        -   inserting a tissue modification tip comprising an energy            window configured to deliver energy therethrough into the            patient's body; and        -   extending the tissue modification tip through the path to            the target tissue area.    -   520. The method of example 519, further comprising at least one        of removing an organ and accessing an organ at the target tissue        area using the lysing tip.    -   521. The method of example 520, further comprising using the        tissue modification tip to achieve hemostasis at the target        tissue area.        -   The method of example 520, wherein the organ comprises at            least one of a muscle, a parotid gland, a salivary gland, a            thyroid gland, a lung, a heart, a liver, a pancreas, a            spleen, a gallbladder, a kidney, an adrenal gland, a            prostate, an ovary, a uterus, a bladder, a blood vessel, a            nerve, a lymph node, and a bone.    -   522. The method of example 491, further comprising:        -   reconfiguring the lysing tip from the treatment            configuration to the delivery configuration; and        -   withdrawing the lysing tip from the patient's body.    -   523. The method of example 522, wherein the step of        reconfiguring the lysing tip from the treatment configuration to        the delivery configuration comprises rotating the lysing tip        such that a primary axis of the lysing tip extends at least        substantially along a direction of withdrawal of the lysing tip.    -   524. The method of example 523 wherein the step of reconfiguring        the lysing tip from the treatment configuration to the delivery        configuration comprises rotating the lysing tip such that a        primary axis of the lysing tip extends at least substantially        along an axis of a cannula, and wherein the step of withdrawing        the lysing tip comprises withdrawing the lysing tip through the        cannula.    -   525. The method of example 491, further comprising creating a        path to a site of herniated tissue using the lysing tip.    -   526. The method of example 525, further comprising dissecting        tissue around the herniated tissue using the lysing tip to        prepare the site for excision of the herniated tissue.    -   527. The method of example 526, further comprising using the        lysing tip to excise at least a portion of the herniated tissue.    -   528. The method of example 527, further comprising applying        energy to tissue remaining at the site following excision of the        herniated tissue.    -   529. The method of example 528, wherein the step of applying        energy to remaining tissue at the site following excision of the        herniated tissue comprises applying energy using at least one of        the lysing tip and a separate tissue modification tip.    -   530. The method of example 528, further comprising:        -   binding at least some of the remaining tissue; and        -   using at least one of the lysing tip and a separate tissue            modification tip to induce supportive fibrosis at the site.    -   531. The method of example 491, CNS access further comprising        creating a path to at least one of the brain, spinal cord, and        adjacent proximal nerves.    -   532. The method of example 491, further comprising creating a        path to a peripheral nerve using the lysing tip.    -   533. The method of example 532, further comprising using the        lysing tip to remove at least one of a tumor and fibrotic tissue        from the peripheral nerve.    -   534. The method of example 533, wherein the step of using the        lysing tip to remove at least one of a tumor and fibrotic tissue        from the peripheral nerve is performed without delivering        electrosurgical energy to the at least one lysing segment.    -   535. The method of example 534, wherein the step of creating a        path to a peripheral nerve using the lysing tip is performed at        least in part while delivering electrosurgical energy to the at        least one lysing segment.    -   536. The method of example 533, further comprising, following        the step of using the lysing tip to remove at least one of a        tumor and fibrotic tissue from the peripheral nerve:        -   activating the lysing tip so as to deliver electrosurgical            energy through the at least one lysing segment; and        -   inducing hemostasis at a site of removal of the at least one            of a tumor and fibrotic tissue using the lysing tip.    -   537. The method of example 491, further comprising using the        lysing tip to create at least a portion of a tissue flap.    -   538. The method of example 537, wherein the tissue flap        comprises at least one of a skin flap, a muscle flap, and a        mucosal flap.    -   539. The method of example 538, further comprising using the        tissue flap in a breast reconstruction procedure wherein the        tissue flap comprises at least one of a latissimus dorsi flap        and a transverse rectus abdominus myocutaneous flap.    -   540. The method of example 491, using the lysing tip to create        at least a portion of a tissue graft.    -   541. The method of example 541, wherein the tissue graft        comprises at least one of a skin graft, fat graft, fascial        graft, vascular graft, connective tissue graft, and mucosal        graft.    -   542. The method of example 491, further comprising:        -   creating a path to a target organ having a tumor using the            lysing tip; and        -   removing at least a portion of the tumor from the target            organ.    -   543. The method of example 542, further comprising:        -   activating an electrosurgical generator to deliver            electrosurgical energy to the at least one lysing segment;            and        -   using the lysing tip to induce hemostasis following removal            of the at least a portion of the tumor from the target            organ.    -   544. The method of example 491, further comprising creating a        tip deployment pocket within the patient's body.    -   545. The method of example 544, wherein the tip deployment        pocket comprises a width running along or at least substantially        parallel to a length of the entrance incision, and wherein the        width of the tip deployment pocket is greater than the length of        the entrance incision.    -   546. The method of example 545, wherein the lysing tip comprises        a lysing tip length between a first outer protrusion of the        plurality of protrusions and a second outer protrusion of the        plurality of protrusions opposite from the first outer        protrusion, and wherein the width of the tip deployment pocket        is greater than or equal to the lysing tip length.    -   547. The method of example 546, wherein the width of the width        of the tip deployment pocket is at least about 150% of the        lysing tip length.    -   548. The method of example 544, wherein the tip deployment        pocket comprises a rectangular shape.    -   549. The method of example 544, wherein the tip deployment        pocket comprises a circular shape.    -   550. The method of example 544, wherein the step of creating a        tip deployment pocket comprises:        -   inserting a blunt instrument through the entrance incision;            and        -   using the blunt instrument to separate tissue adjacent to            the entrance incision into upper and lower planes defining            the tip deployment pocket.    -   551. The method of example 544, wherein the step of creating a        tip deployment pocket is performed without using the lysing tip,        and wherein the step of creating a tip deployment pocket is        performed before the step of delivering a lysing tip through an        entrance incision into a patient's body.    -   552. The method of example 551, wherein the step of delivering a        lysing tip through an entrance incision into a patient's body        comprises delivering the lysing tip through a cannula with an        elongated axis of the lysing tip extending along an axis of the        cannula.    -   553. The method of example 552, wherein the step of        reconfiguring the lysing tip from the delivery configuration to        the treatment configuration comprises:        -   extending the lysing tip out of a distal end of the cannula            into the tip deployment pocket; and        -   rotating the lysing tip such that the elongated axis extends            at an at least substantially perpendicular angle relative to            the axis of the cannula in the tip deployment pocket.    -   554. The method of example 553, wherein the step of rotating the        lysing tip comprises rotating the lysing tip such that at least        one end of the lysing tip defining the elongated axis extends        beyond a cross-sectional profile of the cannula.    -   555. The method of example 554, wherein the step of rotating the        lysing tip comprises rotating the lysing tip such that both        opposing ends of the lysing tip defining the elongated axis        extend beyond a cross-sectional profile of the cannula.    -   556. The method of example 553, further comprising using the        lysing tip to create a path to at least one of an apocrine gland        and an eccrine gland.    -   557. The method of example 556, further comprising:        -   activating an electrosurgical generator to deliver            electrosurgical energy to the at least one lysing segment;            and        -   using the lysing tip to apply electrosurgical energy to the            at least one of an apocrine gland and an eccrine gland to            incapacitate the at least one of an apocrine gland and an            eccrine gland.    -   558. The method of example 544, further comprising using a fluid        delivery canal to deliver fluid within the patient's body to a        region adjacent to the lysing tip during a surgical procedure        using the lysing tip.    -   559. The method of example 544, further comprising:        -   using the lysing tip to create a path to a hair follicle            region;        -   activating an electrosurgical generator to deliver            electrosurgical energy to the at least one lysing segment of            the lysing tip; and        -   using the lysing tip to apply electrosurgical energy to one            or more hair follicles in the hair follicle region, wherein            the electrosurgical energy results in the one or more hair            follicles being incapacitated.    -   560. The method of example 544, wherein the entrance incision is        between about 2 mm and about 12 mm in length, wherein the tip        deployment pocket comprises a width running along or at least        substantially parallel to the length of the entrance incision,        and wherein the width of the tip deployment pocket is greater        than the length of the entrance incision.    -   561. The method of example 560, wherein the width of the tip        deployment pocket is greater than a length of the lysing tip        extending between a first outer protrusion of the plurality of        protrusions and a second outer protrusion of the plurality of        protrusions opposite from the first outer protrusion.    -   562. The method of example 560, wherein the width of the tip        deployment pocket is about 1 cm.    -   563. The method of example 562, wherein the tip deployment        pocket comprises a rectangular shape, wherein a length of the        tip deployment pocket extending at least substantially        perpendicular to the width is between about 1 cm and about 2 cm.    -   564. The method of example 560, further comprising:        -   using the lysing tip to create a first path from the tip            deployment pocket to a first cellulite treatment zone; and        -   using the lysing tip to treat cellulite in the first            cellulite treatment zone.    -   565. The method of example 564, further comprising using the        lysing tip to create a second path from the tip deployment        pocket to the first cellulite treatment zone.    -   566. The method of example 565, wherein the second path is        angled relative to the first path.    -   567. The method of example 564, further comprising:        -   using the lysing tip to create a second path from the tip            deployment pocket to a second cellulite treatment zone            spaced apart from the first cellulite treatment zone; and        -   using the lysing tip to treat cellulite in the second            cellulite treatment zone.    -   568. The method of example 564, wherein the step of using the        lysing tip to treat cellulite in the first cellulite treatment        zone comprises:        -   manipulating the first cellulite treatment zone to move a            top portion of the first cellulite treatment zone into the            first path; and        -   advancing the lysing tip into the first cellulite treatment            zone to treat cellulite in the top portion of the first            cellulite treatment zone.    -   569. The method of example 568, wherein the step of using the        lysing tip to treat cellulite in the first cellulite treatment        zone further comprises:        -   manipulating the first cellulite treatment zone to move a            bottom portion of the first cellulite treatment zone into            the first path; and        -   advancing the lysing tip into the first cellulite treatment            zone to treat cellulite in the bottom portion of the first            cellulite treatment zone.    -   570. The method of example 564, wherein the step of using the        lysing tip to treat cellulite in the first cellulite treatment        zone comprises:        -   delivering electrosurgical energy to the at least one lysing            segment; and        -   using the electrosurgical energy to denature tissues in the            in the first cellulite treatment zone.    -   571. The method of example 564, wherein a single entrance        incision is used to treat cellulite in a first plurality of        cellulite treatment zones along the patient's first leg, and        further comprising:        -   forming a second entrance incision;        -   forming a second tip deployment pocket; and        -   using the lysing tip to treat cellulite in a second            plurality of cellulite treatment zones along the patient's            second leg from the second entrance incision.    -   572. The method of example 544, wherein the step of creating a        tip deployment pocket comprises creating the tip deployment        pocket adjacent to the entrance incision.    -   573. The method of example 544, further comprising:        -   reconfiguring the lysing tip from the treatment            configuration to the delivery configuration; and        -   withdrawing the lysing tip through the entrance incision.    -   574. The method of example 573, wherein the step of        reconfiguring the lysing tip from the treatment configuration to        the delivery configuration comprises rotating the lysing tip        such that an elongated axis of the lysing tip extends at least        substantially in a withdrawal direction.    -   575. The method of example 574, wherein the withdrawal direction        extends along an axis of a cannula, and wherein the step of        withdrawing the lysing tip comprises withdrawing the lysing tip        through the cannula.    -   576. The method of example 491, further comprising creating a        tip deployment pocket within at least one of a patient's neck        and head, wherein the surgical procedure comprises at least one        of a facelift and a necklift procedure.    -   577. The method of example 576, further comprising forming at        least one treatment path using the lysing tip from the tip        deployment pocket along at least one of a patient's face and        neck.    -   578. The method of example 577, wherein the step of forming at        least one treatment path comprises forming a plurality of        overlapping treatment paths using the lysing tip from the tip        deployment pocket along the at least one of the patient's face        and neck.    -   579. The method of example 578, further comprising activating        the at least one lysing segment to deliver electrosurgical        energy to tissue adjacent to the at least one treatment path        using the lysing tip.    -   580. The method of example 577, further comprising:        -   withdrawing the lysing tip from the entrance incision;        -   inserting a tissue modification tip comprising an energy            window configured to deliver energy therethrough through the            entrance incision; and        -   using the tissue modification tip to modify tissue adjacent            to the at least one treatment path to tighten the tissue            adjacent to the at least one treatment path.    -   581. The method of example 580, wherein the energy window is        positioned on an upper surface of the tissue modification tip.    -   582. The method of example 581, wherein the step of using the        tissue modification tip to modify tissue adjacent to the at        least one treatment path comprises positioning the energy window        to face an upper surface of the at least one treatment path        closer to an exterior surface of the patient's skin.    -   583. The method of example 581, wherein the step of using the        tissue modification tip to modify tissue adjacent to the at        least one treatment path comprises positioning the energy window        to face a lower surface of the at least one treatment path        further from an exterior surface of the patient's skin.    -   584. The method of example 491, further comprising using the        lysing tip to dissect the patient's scalp.    -   585. The method of example 491, further comprising:        -   forming a plurality of entrance incisions;        -   inserting the lysing tip within each of the entrance            incisions; and        -   using the lysing tip to dissect the patient's scalp adjacent            to each of the entrance incisions.    -   586. The method of example 491, further comprising creating a        tip deployment pocket adjacent to the patient's scalp.    -   587. The method of example 586, further comprising:        -   inserting the lysing tip in the tip deployment pocket; and        -   after inserting the lysing tip in the tip deployment pocket,            reconfiguring the lysing tip from the delivery configuration            to the treatment configuration in the tip deployment pocket.    -   588. The method of example 587, further comprising:        -   forming a plurality of entrance incisions adjacent to the            patient's scalp;        -   forming a plurality of tip deployment pockets adjacent to            the plurality of entrance incisions;        -   deploying the lysing tip in each of the plurality of tip            deployment pockets; and        -   forming a scalp dissection path using the lysing tip from            each of the tip deployment pockets to separate the patient's            scalp from its underlying structure.    -   589. The method of example 491, wherein the electrosurgical        procedure comprises installing at least one of a biomedical        implant and a cosmetic implant within the patient, and further        comprising creating a path to a location adjacent to an implant        zone where the at least one of a biomedical implant and a        cosmetic implant will be installed using the lysing tip.    -   590. The method of example 589, further comprising using the        lysing tip to create an implant pocket in tissue in the implant        zone, wherein the implant pocket is configured to receive the at        least one of a biomedical implant and a cosmetic implant.    -   591. The method of example 590, wherein the at least one of a        biomedical implant and a cosmetic implant comprises a biomedical        implant, and wherein the biomedical implant comprises at least        one of a pump, a pacemaker, a neurological implant, a drug        delivery device, a tracking implant, and an ID chip.    -   592. The method of example 590, wherein the at least one of a        biomedical implant and a cosmetic implant comprises a cosmetic        implant, and wherein the cosmetic implant comprises at least one        of a skin implant, a breast implant, a face implant, and a        muscle implant.    -   593. The method of example 590, further comprising:        -   forming a tip deployment pocket; and        -   deploying the lysing tip in the tip deployment pocket by            inserting the lysing tip in the tip deployment pocket and            reconfiguring the lysing tip from the delivery configuration            to the treatment configuration in the tip deployment pocket.    -   594. The method of example 593, wherein the tip deployment        pocket is formed adjacent to the implant zone.    -   595. The method of example 593, wherein the tip deployment        pocket is formed adjacent to the entrance incision.    -   596. The method of example 593, further comprising advancing the        at least one of a biomedical implant and a cosmetic implant to        the implant zone and inserting the at least one of a biomedical        implant and a cosmetic implant in the implant pocket.    -   597. The method of example 491, wherein the electrosurgical        procedure comprises at least one of a capsulotomy and a        capsulectomy.    -   598. The method of example 597, further comprising using the        lysing tip to create a path to an implant having a capsule of        scar tissue adjacent to the implant.    -   599. The method of example 598, further comprising using the        lysing tip to separate at least a portion of the capsular        fibrous tissue from the implant.    -   600. The method of example 598, wherein the implant comprises a        breast implant.    -   601. The method of example 598, wherein the implant comprises a        hip implant.    -   602. An electrosurgical lysing tip, comprising:        -   a first outer protrusion;        -   a second outer protrusion opposite from the first outer            protrusion;        -   at least one inner bead positioned in between the first            outer protrusion and the second outer protrusion, wherein            each of the at least one inner bead defines an inner            protrusion;        -   at least one lysing member defining at least one lysing            segment between each pair of adjacent protrusions; and        -   a support member extending between the first outer            protrusion and the second outer protrusion, wherein the            support member is configured to facilitate coupling of the            lysing tip to a surgical tool used to control the lysing tip            during a surgical procedure within a patient's body.    -   603. The electrosurgical lysing tip of example 602, wherein the        first outer protrusion is defined by a first outer bead, and        wherein the second outer protrusion is defined by a second outer        bead positioned on an opposite end of the lysing tip relative to        the first outer bead.    -   604. The electrosurgical lysing tip of example 603, wherein each        of the first outer bead and the second outer bead comprises a        leading end protruding distally of the at least one lysing        member, and wherein each of the first outer bead and the second        outer bead comprises a trailing end protruding proximally from        the support member.    -   605. The electrosurgical lysing tip of example 603, wherein the        first outer bead is non-rigidly coupled to the support member at        a first end of the support member, and wherein the second outer        bead is non-rigidly coupled to the support member at a second        end of the support member opposite from the first end.    -   606. The electrosurgical lysing tip of example 603, wherein the        first outer bead and the second outer bead each comprises an        inner recess, and wherein each inner recess is configured to        receive a respective portion of the support member therein.    -   607. The electrosurgical lysing tip of example 606, wherein each        inner recess is configured to receive a respective end portion        of the support member such that each opposing end of the support        member terminates in an inner recess.    -   608. The electrosurgical lysing tip of example 606, wherein each        inner recess is configured to loosely receive a respective        portion of the support member therein such that the first outer        bead and the second outer bead can move relative to the support        member during a surgical procedure.    -   609. The electrosurgical lysing tip of example 602, wherein the        first outer protrusion comprises an integral portion of the        support member at a first end of the support member, and wherein        the second outer protrusion comprises an integral portion of the        support member at a second end of the support member opposite        from the first end.    -   610. The electrosurgical lysing tip of example 602, wherein the        first outer protrusion and the second outer protrusion each        comprises a shape that at least substantially mimics the shapes        of each of the at least one inner bead along a leading end of        the first outer protrusion and the second outer protrusion.    -   611. The electrosurgical lysing tip of example 602, wherein the        first outer protrusion is defined by a first outer bead, wherein        the second outer protrusion is defined by a second outer bead        positioned on an opposite end of the lysing tip relative to the        first outer bead, and wherein the first outer bead and the        second outer bead each comprises an at least substantially        ellipsoidal shape.    -   612. The electrosurgical lysing tip of example 611, wherein each        of the at least one inner bead comprises a leading end having an        at least substantially ellipsoidal shape.    -   613. The electrosurgical lysing tip of example 612, wherein each        of the at least one inner bead further comprises a flattened        trailing end.    -   614. The electrosurgical lysing tip of example 613, wherein each        of the at least one inner bead comprises a flattened trailing        end that terminates adjacent to the support member.    -   615. An electrosurgical system, comprising:        -   a lysing tip comprising:            -   a plurality of beads; and            -   a lysing member extending through each of the plurality                of beads such that each of the plurality of beads                protrudes beyond the lysing member; and        -   a surgical tool configured to selectively couple with the            lysing tip, wherein the surgical tool comprises a pair of            jaws configured to selectively engage at least a portion of            the lysing tip.    -   616. The electrosurgical system of example 615, wherein the        lysing member comprises a first coupling tip formed at a first        end of the lysing member and a second coupling tip formed at a        second end of the lysing member opposite from the first end, and        wherein the surgical tool is configured to selectively engage        the lysing tip at the first coupling tip and the second coupling        tip.    -   617. The electrosurgical system of example 616, wherein the        lysing member comprises a lysing rod comprising an at least        substantially circular cross-section, and wherein the first and        second coupling tips comprise enlarged portions of the lysing        rod.    -   618. The electrosurgical system of example 616, wherein the        first coupling tip comprises an enlarged end, wherein the second        coupling tip comprises a second enlarged end, wherein a first        jaw of the pair of jaws is configured to engage the first        coupling tip at the first end, and wherein a second jaw of the        pair of jaws is configured to engage the second coupling tip at        the second end.    -   619. The electrosurgical system of example 615, wherein each of        the plurality of beads is configured to rotate with respect to        the lysing member.    -   620. The electrosurgical system of example 615, further        comprising a plurality of spacers coupled with the lysing        member, wherein each of the plurality of spacers is positioned        between a pair of adjacent beads of the plurality of beads.    -   621. The electrosurgical system of example 620, further        comprising a first outer spacer positioned in between a first        outer bead of the plurality of beads and an adjacent bead and a        second outer spacer positioned in between a second outer bead of        the plurality of beads opposite from the first outer bead and an        adjacent bead.    -   622. The electrosurgical system of example 615, wherein the        surgical tool is configured to deliver electrosurgical energy to        the lysing member when the lysing tip is selectively engaged        with the surgical tool.    -   623. The electrosurgical system of example 622, wherein the        surgical tool is configured to deliver electrosurgical energy to        the lysing tip through at least one jaw of the pair of jaws.    -   624. The electrosurgical system of example 615, wherein each of        the plurality of beads comprises an at least substantially        ellipsoidal leading end.    -   625. The electrosurgical system of example 624, wherein each of        the plurality of beads comprises a flattened trailing end.    -   626. An electrosurgical lysing tip, comprising:        -   a plurality of beads;        -   at least one lysing member extending at least partially            through each of the plurality of beads to couple the            plurality of beads together, wherein the at least one lysing            member defines at least one lysing segment between each pair            of adjacent beads of the plurality of beads;        -   a treatment portion coupled with the at least one lysing            member;        -   a base portion removably couplable with the treatment            portion and configured such that, following an            electrosurgical procedure with the electrosurgical lysing            tip, the treatment portion may be removed from the base            portion and a new treatment portion with a new at least one            lysing member and a new plurality of beads coupled with the            base portion for a subsequent electrosurgical procedure.    -   627. The electrosurgical lysing tip of example 626, wherein the        base portion comprises at least one hole configured to couple        the base portion with a deployment assembly of a surgical        instrument.    -   628. The electrosurgical lysing tip of example 626, wherein the        base portion and the treatment portion together define a support        member for the electrosurgical lysing tip, wherein the support        member is configured to facilitate coupling of the        electrosurgical lysing tip to a surgical instrument used to        control the lysing tip during an electrosurgical procedure        within a patient's body.    -   629. The electrosurgical lysing tip of example 628, wherein the        treatment portion is configured to mate with the base portion        such that the treatment portion defines a distal portion of the        support member and the base portion defines a proximal portion        of the support member.

The features, structures, steps, or characteristics disclosed herein inconnection with one embodiment may be combined in any suitable manner inone or more alternative embodiments.

The term dissection may indicate the separation of tissues or of onetissue plane from another (ref: Free Online Medical Dictionary). Somealso consider dissection to comprise separation of a single tissue intoportions. Much of the bodies of animals and humans are formed fromembryonic fusion planes. Many of the organs of the human or animal bodymay be categorized from the embryonic fusion planes from whence theycame. The interfaces between organs may often be referred to as ‘tissueplanes.’ Such planes may be considered substantially planar dependingupon the size of a comparative planar living or inanimate object (suchas a surgical instrument). Some embodiments disclosed herein maycomprise cannula-delivered tissue dissectors (CDTD). Other embodimentsdisclosed herein may be used without a cannula and may therefore beconsidered non-cannula-delivered tissue dissectors (non-CDTD). Someembodiments may be used either with or without cannulas and therefore,depending upon the systems/procedure, may be considered CDTD ornon-CDTD. Both the CDTD and non-CDTD embodiments disclosed herein mayperform the functions of sharp dissection, blunt dissection,electrosurgical cutting and/or coagulation simultaneously without asurgeon having to switch instruments. Tissue modification may also becarried out.

Sharp dissection has been referred to by some as separation of tissuesby means of the sharp edge of a knife or scalpel or with the inner sharpedge of scissors. Blunt dissection has been defined by Webster assurgical separation of tissue layers by means of an instrument without acutting edge or by the fingers.

The term ‘minimally invasive surgery’ has been used to describe aprocedure (surgical or otherwise) that is less invasive than opensurgery used for the same purpose. Some minimally invasive procedurestypically involve use of laparoscopic and/or endoscopic devices andmanual and/or remote/computerized manipulation of instruments withindirect observation of the surgical field through an endoscope orsimilar device, and are carried out through the skin or through a bodycavity or anatomical opening. This may result in shorter hospital stays,or allow outpatient treatment (reference: Wikipedia).

Sometimes minimally invasive surgery is known as “keyhole” surgery andmay be performed using one or more trocars and one or more laparoscopesand/or endoscopes and/or cannulae to access tissues within the body.

The term ‘open surgery’ is used to indicate cutting skin and tissues to‘open the body’ so that the surgeon has direct access to the structuresor organs involved. An incision may of the size that permits a surgeon'shands to enter the patient's body. The structures and tissues involvedmay be seen and touched and may be directly exposed to the air of theoperating room.

The term “cannula,” as used herein, is intended to encompass any tube ortubular structure that is configured to be inserted into the body of ahuman or animal during a surgical procedure and facilitate selectivemovement of a surgical device and/or related components for performingdelivery of the surgical device and/or surgical procedures with thesurgical device. Tubular structures that contain fixedstructures/elements therein, such as needle drivers or graspinginstruments, are not considered cannulas as that term is used herein.Although often “trocars” are used in connection with cannulas, the termcannula, as used herein, is intended to encompass a trocar alone if sucha trocar is capable of being used to insert a medical device into abody.

It may be advantageous to have a spot coagulator extend from anembodiment of the CDTD at such a distance and/or location that allowscomplete viewing and/or contact of a bleeding area with a portion of thespot coagulator (for example the distal end point of a tip of thecoagulator). Such a probe may be deployable and may obtain electricalenergy off of a conductive element located between the lysing elementsof the tip and the plug.

BRIEF DESCRIPTION OF THE DRAWINGS

The written disclosure herein describes illustrative embodiments thatare non-limiting and non-exhaustive. Reference is made to certain ofsuch illustrative embodiments that are depicted in the figures, inwhich:

FIG. 1 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 1 b is a perspective view of the embodiment previously depicted inFIG. 1 a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 1 c is a perspective view of the embodiment previously depicted inFIG. 1 a in the delivery configuration.

FIG. 1 d is an upper view of the lysing tip in FIG. 1 a and the distalportions of the cannulas.

FIG. 1 e is an upper view of lysing tip of the embodiment shown in FIG.1 a.

FIG. 1 f is a rear perspective view of the lysing tip and actuation armsof the embodiment shown in FIG. 1 a.

FIG. 1 g is perspective view of the protrusion base of the embodimentshown in FIG. 1 a.

FIG. 1 h is a perspective view of the lysing member of the embodimentshown in FIG. 1 a.

FIG. 1 i is a side view of a hand assembly that may be used with theembodiment shown in FIG. 1 a.

FIG. 1 j is perspective view of the embodiment shown in FIG. 1 a used inconnection with a single cannula.

FIG. 2 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 2 b is a perspective view of the embodiment previously depicted inFIG. 2 a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 2 c is a perspective view of the embodiment previously depicted inFIG. 2 a in the delivery configuration.

FIG. 2 d is an upper view of the lysing tip in FIG. 2 a and the distalportion of the cannulas.

FIG. 2 e is a perspective view of the embodiment previously depicted inFIG. 2 a used in connection with a single cannula.

FIG. 3 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 3 b is a perspective view of the embodiment previously depicted inFIG. 3 a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 3 c is a perspective view of the embodiment previously depicted inFIG. 3 a in the delivery configuration.

FIG. 3 d is an upper view of the lysing tip in FIG. 3 a and the distalportion of the cannulas.

FIG. 3 e is a perspective view of the embodiment previously depicted inFIG. 3 a used in connection with a single cannula.

FIG. 4 a is a perspective view of an embodiment of a system for deliveryof a bipolar lysing tip through a cannula in a treatment configuration.

FIG. 4 b is a perspective view of the embodiment previously depicted inFIG. 4 a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 4 c is a perspective view of the embodiment previously depicted inFIG. 4 a in the delivery configuration.

FIG. 4 d is an upper view of the lysing tip in FIG. 4 a and the distalportion of the cannulas.

FIG. 4 e is a perspective view of the protrusion base of the embodimentpreviously depicted in FIG. 4 a.

FIG. 4 f is a perspective view of the lysing members of the embodimentpreviously depicted in FIG. 4 a.

FIG. 4 g is a rear perspective view of the embodiment previouslydepicted in FIG. 4 a including the rear of the lysing tip and theactuation rods.

FIG. 4 h is a perspective view of the embodiment previously depicted inFIG. 4 a used in connection with a single cannula.

FIG. 5 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 5 b is a perspective view of the embodiment previously depicted inFIG. 5 a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 5 c is a perspective view of the embodiment previously depicted inFIG. 5 a in the delivery configuration.

FIG. 5 d is an upper view of the lysing tip in FIG. 5 a and the distalportion of the cannulas.

FIG. 5 e is a perspective view of the embodiment previously depicted inFIG. 5 a used in connection with a single cannula.

FIG. 6 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 6 b is a perspective view of the embodiment previously depicted inFIG. 6 a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 6 c is a perspective view of the embodiment previously depicted inFIG. 6 a in the delivery configuration.

FIG. 6 d is an upper view of the lysing tip in FIG. 6 a and the distalportion of the cannulas.

FIG. 6 e is a perspective view of the embodiment previously depicted inFIG. 6 a used in connection with a single cannula.

FIG. 7 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula via a grasping/control instrument.

FIG. 7 b is an upper plan view of the embodiment previously depicted inFIG. 7 a.

FIG. 7 c is a close-up side view of the embodiment previously depictedin FIG. 7 a wherein a lysing tip is reattached.

FIG. 7 d is an upper plan view of the lysing tip of the embodimentpreviously depicted in FIG. 7 a.

FIG. 7 e is a side view of the embodiment previously depicted in FIG. 7a , wherein the lysing tip is uncoupled from the grasping/controlinstrument.

FIG. 7 f is a side view of the grasping/control instrument of theembodiment previously depicted in FIG. 7 a.

FIG. 8 a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a single cannula via a grasping/controlinstrument further comprising a tether.

FIG. 8 b is a close-up side view of the distal end of the embodimentpreviously depicted in FIG. 8 a wherein the tip is coupled to theinstrument tip.

FIG. 8 c is a close-up side view of the distal end of thegrasping/control instrument of the embodiment previously depicted inFIG. 8 a.

FIG. 8 d is a close-up, cross-sectional side view of the distal end ofthe embodiment previously depicted in FIG. 8 a wherein the tip iscoupled to the instrument tip.

FIG. 8 e is a close-up perspective view of the distal end of theembodiment previously depicted in FIG. 8 a wherein the tip is uncoupledfrom the instrument tip yet tethered.

FIG. 8 f is a close-up perspective view of the distal end of theembodiment previously depicted in FIG. 8 a wherein the tip is uncoupledfrom the instrument tip yet tethered and upside down.

FIG. 9 is an upper plan view of a non-axial lysing tip.

FIG. 10 a is a perspective view of yet another embodiment of a systemfor delivery of a lysing tip through a cannula in a treatmentconfiguration.

FIG. 10 b is an upper plan, close-up view of the embodiment previouslydepicted in FIG. 10 a in a treatment configuration.

FIG. 10 c is a close-up upper plan view of the embodiment previouslydepicted in FIG. 10 a showing beads, protuberances, and lysing tip.

FIG. 10 d is a side view through the tunnel of a bead of the embodimentpreviously depicted in FIG. 10 a.

FIG. 10 e is a close-up, upper plan view of the lysing tip depicted inFIG. 10 c illustrating the lysing tip in a stressed/deformed state.

FIG. 10 f is an upper view of the embodiment previously depicted in FIG.10 a with lysing tip in delivery configuration.

FIG. 10 g is a side view of the embodiment previously depicted in FIG.10 a illustrating the coupling of the lysing member to the actuationrod.

FIG. 10 h is an upper view of the embodiment previously depicted in FIG.10 f illustrating that tip may not fit within one or more cannulas.

FIG. 11 a is a perspective view of an embodiment of a system fordelivery of a lysing tip through a cannula in a treatment configuration.

FIG. 11 b is an upper plan, close-up view of the embodiment previouslydepicted in FIG. 11 a in a treatment configuration.

FIG. 11 c is a close-up upper plan view of the embodiment previouslydepicted in FIG. 11 a showing beads, a spacer, and lysing tip.

FIG. 11 d is a side view through the tunnel of a bead with facetscomprising the embodiment previously depicted in FIG. 11 a.

FIG. 11 e is a close-up upper plan view of the lysing tip depicted inFIG. 11 c illustrating the lysing tip in a stressed/deformed state withspacers.

FIG. 11 f is an upper view of the embodiment previously depicted in FIG.11 b illustrating that tip may not fit within one or more cannulas.

FIG. 12 a comprises a perspective view of a lysing member/lysing rodwith a circular cross-section.

FIG. 12 b comprises a perspective view of a lysing member/lysing rodwith a triangular cross-section.

FIG. 12 c comprises a perspective view of a lysing member/lysing rodwith a rectangular cross-section.

FIG. 12 d comprises a perspective view of a lysing member/lysing rodwith a pentagonal cross-section.

FIG. 12 dx comprises a perspective view of a lysing member/lysing rodhaving a pentagonal cross section that is twisted along its length.

FIG. 12 e comprises a perspective view of a lysing member/lysing rodwith a hexagonal cross-section.

FIG. 12 f comprises a perspective view of a lysing member/lysing rodwith a wedge cross-section.

FIG. 12 g comprises a perspective view of a lysing member/lysing rodwith a half-circle cross-section.

FIG. 12 h comprises a perspective view of a spacer to a lysing tip witha hole through its length having a circular cross-section withnon-beveled ends.

FIG. 12 i comprises a perspective view of a spacer to a lysing tip witha hole through its length having a circular cross-section with beveledends.

FIG. 12 j comprises a perspective view of a spacer to a lysing tip witha hole through its length having a circular cross-section with beveledends and holes.

FIG. 12 k comprises a perspective view of a spacer to a lysing tip witha hole through its length having a circular cross-section arced alongits length.

FIG. 12L comprises a perspective view of a spacer to a lysing tip withopposing loops connected by a rod in a relaxed state.

FIG. 12 m comprises a perspective view of a spacer to a lysing tip withopposing loops connected by a rod in a stressed state.

FIG. 12 n comprises a perspective view of a spacer to a lysing tip witha hole through its length having a triangular cross-section.

FIG. 12 o comprises a perspective view of a spacer to a lysing tip witha hole through its length having a rectangular cross-section.

FIG. 12 p comprises a perspective view of a spacer to a lysing tip witha hole through its length having a pentagonal cross-section.

FIG. 12 px comprises a perspective view of a spacer to a lysing tip witha hole through its length having a pentagonal cross section that istwisted along its length.

FIG. 12 q comprises a perspective view of a spacer to a lysing tip witha hole through its length having a hexagonal cross-section.

FIG. 12 r comprises a perspective view of a spacer to a lysing tip witha hole through its length having a blade-shaped cross-section withrounded edges.

FIG. 12 s comprises a perspective view of a spacer to a lysing tip witha hole through its length having a blade-shaped cross-section with flatedges.

FIG. 12 t comprises a perspective view of a spacer to a lysing tip witha hole through its length having a spindle cross-section.

FIG. 12 aa is a perspective view of a bead having a spherical shape.

FIG. 12 bb is a perspective view of a bead having a wheel shape.

FIG. 12 cc is a perspective view of a bead having a dodecahedron shape.

FIG. 12 dd is a perspective view of a bead having a substantiallyellipsoidal shape.

FIG. 12 ee is a perspective view of a bead having a substantiallyellipsoidal shape with facets.

FIG. 12 ff is a perspective view of a bead having a substantiallyellipsoidal shape able to accept a sleeve.

FIG. 12 gg is a perspective view of a bead having a partiallyellipsoidal shape with a flat proximal end and facets.

FIG. 12 hh is a perspective view of a bead having a partiallyellipsoidal shape with two flat surfaces on its proximal end.

FIG. 12 ii is an upper view of a bead having a partially ellipsoidalshape with convex proximal end.

FIG. 12 jj is an upper view of a bead having a partially ellipsoidalshape with an asymmetric proximal end with facets.

FIG. 12 kk is an upper view of a bead having a partially ellipsoidalshape with an angular cut-out on its proximal end.

FIG. 12LL is an upper view of a bead having a partially ellipsoidalshape with a concave proximal end.

FIG. 12 mm is a side view, from the outside, of an outer bead having asubstantially annular shape.

FIG. 12 nn is a side view, from the inside, of bead depicted in FIG. 12mm.

FIG. 1200 is a side view of a deformable bead having a substantiallyannular shape.

FIG. 12 pp is a side view of a middle bead having a substantiallyannular shape and knobs on its proximal end.

FIG. 12 qq is a side view of a middle bead having a substantiallyannular shape and a cross-member at its proximal end.

FIG. 12 rr is a side perspective view of a bead comprising a slotconfigured to engage a lysing member.

FIG. 13 a is a perspective view of an embodiment of a system fordelivery of a lysing tip comprising a bar through a cannula in atreatment configuration.

FIG. 13 b is a perspective view of the embodiment previously depicted inFIG. 13 a in a partially retracted configuration, in between thedelivery and treatment configurations.

FIG. 13 c is a perspective view of the embodiment previously depicted inFIG. 13 a in the delivery configuration.

FIG. 13 d is an upper view of the lysing tip in FIG. 13 a and the distalportion of the cannulas.

FIG. 13 e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 13 a.

FIG. 13 f is an upper view of the assembled lysing tip with actuationarms of the embodiment previously depicted in FIG. 13 a.

FIG. 13 g is an upper view of the embodiment previously depicted in FIG.13 a , more specifically of the lysing tip without actuation arms.

FIG. 13 h is an upper view of the lysing plate comprising theembodiment.

FIG. 13 i is a side view of the lysing tip.

FIG. 14 a is an upper perspective view of an alternative embodiment of alysing tip delivered through one or more cannulas in the treatmentconfiguration.

FIG. 14 b is an upper perspective view of the embodiment in FIG. 14 a ina partially deployed configuration, between the treatment and deliveryconfigurations.

FIG. 14 c is an upper perspective view of the embodiment in FIG. 14 a ina delivery configuration.

FIG. 14 d is an upper view of the lysing tip in FIG. 14 a and the distalportion of the cannulas.

FIG. 14 e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 14 a.

FIG. 14 f is a side view of the lysing tip of the embodiment previouslydepicted in FIG. 14 a.

FIG. 14 g is an upper view of the embodiment previously depicted in FIG.14 a , more specifically of the lysing tip without actuation arms.

FIG. 14 h is an upper view of the lysing tip with certain componentsremoved to view structures beneath.

FIG. 14 i is a perspective view of lysing tip in the deliveryconfiguration being too large to enter the inner cannula but ofsufficient dimensions to enter the outer cannula.

FIG. 14 j is an upper perspective view of FIG. 14 i.

FIG. 14 k is a perspective view of the lysing tip of FIG. 14 j in thedelivery configuration with an inner cannula having a diameter smallerthan tip width of the lysing tip.

FIG. 14L is a perspective view of the embodiment of FIG. 14 k withoutthe outer cannula.

FIG. 14 m is a perspective view of the lysing tip of FIG. 14 k in thedelivery configuration with an inner cannula having a diameter smallerthan tip width of the lysing tip which is covered by a protectivesleeve.

FIG. 14 n is a perspective view of the embodiment of FIG. 14L withoutthe outer cannula with the lysing tip covered by a protective sleeve.

FIG. 14 o is a perspective view of an alternative embodiment to thatdepicted in FIG. 14 a in which a treatment portion may be removed fromthe lysing tip.

FIG. 14 p is a perspective view of cross section taken along line A-Afrom FIG. 14 r.

FIG. 14 q is a perspective view of the treatment portion of theembodiment depicted in FIG. 14 o.

FIG. 14 r is an exploded perspective view of the lysing tip of theembodiment of FIG. 14 o.

FIG. 14 s is an exploded, side perspective cross-sectional view takenalong line A-A from FIG. 14 r

FIG. 14 t is an exploded, side cross-sectional view taken along line A-Afrom FIG. 14 r.

FIG. 15 a is an upper perspective view of an alternative embodiment of alysing tip delivered through one or more cannulas in the treatmentconfiguration, said lysing tip being configured with one or more energywindows.

FIG. 15 b is an upper view of the embodiment previously depicted in FIG.15 a , more specifically of the lysing tip with one or more energywindows and actuation arms.

FIG. 15 c is a front view of lysing tip of the embodiment previouslydepicted in FIG. 15 a with energy window strip.

FIG. 15 d is a close-up side view of lysing tip of the embodimentpreviously depicted in FIG. 15 a with energy window strip.

FIG. 15 e is a close-up perspective view of a bead of the embodimentpreviously depicted in FIG. 15 a.

FIG. 15 f is a front view showing lysing tip of the embodimentpreviously depicted in FIG. 15 a with energy window recessed within oneor more cannulas.

FIG. 15 g is an exploded view of an energy window.

FIG. 15 h is a front view of the insulation cover of the embodimentpreviously depicted in FIG. 15 a.

FIG. 15 i is a close-up sectioned side view of the outer bead showingthe insertion of the insulation cover through the bead.

FIG. 15 j is a perspective view of a bipolar lysing tip of theembodiment of FIG. 15 a.

FIG. 15 k is an upper plan view of a bipolar lysing tip of theembodiment of FIG. 15 a.

FIG. 16 a is an upper perspective view of a bipolar embodiment of a CDTDsystem in the treatment configuration.

FIG. 16 b is a perspective view of the embodiment previously depicted inFIG. 16 a in a partially retracted configuration, in between thedelivery and treatment configurations.

FIG. 16 c is a perspective view of the embodiment previously depicted inFIG. 16 a in the delivery configuration.

FIG. 16 d is an upper view of the lysing tip in FIG. 16 a and the distalportion of the cannulas.

FIG. 16 e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 16 a.

FIG. 16 f is an upper view of the lysing tip of the embodimentpreviously depicted in FIG. 16 a.

FIG. 16 g is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 16 a.

FIG. 16 h is a rear view of the beads and wiring of the embodimentpreviously depicted in FIG. 16 a.

FIG. 17 a is an upper plan view of an embodiment of a lysing tip.

FIG. 17 b is a cross sectional view of the embodiment previouslydepicted in FIG. 17 a at the location shown in FIG. 17 a.

FIG. 17 c is an upper plan view of yet another embodiment of a lysingtip.

FIG. 17 d is an upper plan view of still another embodiment of a lysingtip.

FIG. 17 e is a perspective view of the structural member coupled withlysing rod.

FIG. 17 f is a partial breakaway view of the delivery of lysing tip andgrasping/control instrument inside a body, said lysing tip to bereceived and held by a second instrument until the grasping/controlinstrument grasps and controls lysing tip for the surgical procedure.

FIG. 17 g is a perspective view of the interaction between a lysing tip,its grasping/control instrument, and a temporary holding/graspinginstrument.

FIG. 17 h is a side view of a lysing tip and its associated graspingcontrol instrument without a non-conductive sheath.

FIG. 17 i is a side view of a lysing tip and its associated graspingcontrol instrument covered by a non-conductive sheath.

FIG. 17 j is an upper view of a lysing tip depicting middle beads heldvia friction fit and protuberances.

FIG. 17 k is a front view of a lysing tip depicting deformed lysing rodbetween beads.

FIG. 17L is a view of the abdomen depicting the construction of asurgical device to be used therein.

FIG. 17 m is a top plan view of a modular lysing tip depicting internalcomponents of a locking mechanism.

FIG. 18 a is a perspective view of a system comprising a lysing tip andgrasping/control instrument, coupled.

FIG. 18 b is an upper plan view of a lysing tip and grasping controlinstrument, coupled.

FIG. 18 c is a perspective view of a lysing tip and grasping/controlinstrument, uncoupled.

FIG. 18 d is a side view of an outer bead, being the inside view of theouter bead.

FIG. 18 e is a side view of an outer bead, being the outside view of theouter bead.

FIG. 19 a is an upper plan view of a lysing tip comprising a tab.

FIG. 19 b is a side view of a grasping control instrument configured tocouple with the lysing tip in FIG. 19 a.

FIG. 19 c is top view of the lysing tip of the embodiment of FIG. 19 acoupled with an energy strip.

FIG. 19 d is front view of the lysing tip of the embodiment of FIG. 19 acoupled with an energy strip.

FIG. 20 a is a perspective view of system comprising a lysing tipcomprising two outer beads and configured to be used with acorresponding grasping/control instrument that defines a third innerbead when coupled.

FIG. 20 b is a perspective view of the embodiment in FIG. 20 a , withlysing tip uncoupled from its corresponding grasping/control instrument.

FIG. 20 c is an upper plan view of the embodiment of FIG. 20 a , withlysing tip and its corresponding grasping/control instrument.

FIG. 20 d is a perspective view of the embodiment of FIG. 20 a of thelysing plate and its associated side beads.

FIG. 20 e is a side view of the embodiment of FIG. 20 a of the lysingtip illustrating the positioning of lysing plate within bead.

FIG. 20 f is an upper view of the embodiment of FIG. 20 a of the lysingplate and associated side beads.

FIG. 20 g is a front view of the embodiment of FIG. 20 a of lysing plateand associated side beads.

FIG. 20 h is an upper view of the embodiment of FIG. 20 a of lysingplate.

FIG. 20 i is a perspective view of an alternative embodiment to thedevice depicted in of FIG. 20 a in which the lysing member comprises acircular cross section.

FIG. 20 j is a side view of a bead from the embodiment of FIG. 20 idepicting a hole that makes contact with lysing member and a rod tunnelthat does not extend through bead.

FIG. 20 k is a side view of a bead from the embodiment of FIG. 20 idepicting a hole that makes contact with lysing member and a rod tunnelthat does extend through bead.

FIG. 20L is a top view of the lysing tip of FIG. 20 i comprising only arod and beads.

FIG. 20 m is a top view of the lysing tip of FIG. 20 i comprising aspacer and beads.

FIG. 20 n is a top view of the lysing tip of FIG. 20 i comprising a rod,partial spacer and beads.

FIG. 20 o is a side view of a grasping control instrument depicted inFIG. 20 i with a modified distal jaw shape comprising an overbite shape.

FIG. 21 a is a perspective view of an alternative embodiment of a systemcomprising a 2-bulb lysing tip and its associated grasping/controlinstrument, coupled.

FIG. 21 b is a perspective view of the lysing tip and its associatedgrasping/control instrument, uncoupled.

FIG. 21 c is a side view of the embodiment depicted in FIG. 21 a.

FIG. 21 d is an upper plan view of a lysing tip coupled with agrasping/control instrument depicting hidden lines of internalcomponents of a bead on one side.

FIG. 21 e is an upper exploded view showing beads removed from lysingsegment.

FIG. 22 a is a perspective view of an alternative embodiment of a systemcomprising a 2-bulb lysing tip with beads rounded on the proximal endsand its associated grasping/control instrument, coupled.

FIG. 22 b is a perspective view of the lysing tip and its associatedgrasping/control instrument, uncoupled.

FIG. 22 c is a side view of the embodiment depicted in FIG. 22 a.

FIG. 22 d is an upper plan view of a lysing tip coupled with agrasping/control instrument.

FIG. 22 e is an upper exploded view showing beads removed from lysingsegment.

FIG. 23 a is an upper plan view of an alternative embodiment of a systemcomprising a 2-bulb lysing tip illustrating use of cords for retrieval.

FIG. 23 b is a side view of the embodiment depicted in FIG. 23 a of thelysing tip and its associated grasping/control instrument, uncoupled.

FIG. 23 c is a perspective view of the embodiment depicted in FIG. 23 a.

FIG. 23 d is an upper view of the grasping plate and lysing member ofthe embodiment depicted in FIG. 23 a.

FIG. 24 a is a perspective view of a lysing tip configured to couplewith an electrosurgical pencil.

FIG. 24 b is an upper view of the lysing tip of FIG. 24 a coupled to anelectrosurgical pencil.

FIG. 24 c is a perspective view of an alternative lysing tip configuredto couple to an electrosurgical pencil.

FIG. 25 a is a perspective view of an embodiment of a system fordelivery of a lysing tip through a single cannula via a grasping/controlinstrument further comprising a tether.

FIG. 25 b is a close-up side view of the embodiment depicted in FIG. 25a of the distal end of the embodiment previously depicted in FIG. 25 awherein the tip is coupled to the instrument tip.

FIG. 25 c is a close-up side view of the embodiment depicted in FIG. 25a of the distal end of the grasping/control instrument of the embodimentpreviously depicted in FIG. 25 a.

FIG. 25 d is a close-up, cross-sectional side view of the distal end ofthe embodiment previously depicted in FIG. 25 a wherein the tip iscoupled to the instrument tip.

FIG. 25 e is a close-up perspective view of the distal end of theembodiment previously depicted in FIG. 25 a wherein the tip is uncoupledfrom the instrument tip yet tethered and may contain magnets.

FIG. 26 a is an elevated view of a lysing tip comprising a non-axialconfiguration in which the middle spacer is removed.

FIG. 26 b is an elevated view of a lysing tip comprising a non-axialconfiguration in which the middle spacer is present.

FIG. 27 a is an upper plan perspective view of an alternative embodimentfor a lysing tip comprising beads with associated sleeves.

FIG. 27 b is a perspective view of a lysing tip showing two beadsremoved to expose internal components.

FIG. 27 c is an upper plan view showing two beads removed to exposeinternal components.

FIG. 27 d is the exploded perspective view of one end of a lysing tip toshow how a bead is coupled with a lysing rod.

FIG. 27 e is a perspective view of a side bead.

FIG. 27 f are perspective views of an outer sleeve illustrating the twoends of the sleeve.

FIG. 27 g is a side view of an outer bead.

FIG. 27 h is a side perspective view of a middle bead coupled to lysingrod.

FIG. 27 i is the exploded perspective view of a middle bead to show howa bead is coupled with a lysing rod and sleeve.

FIG. 27 j is a perspective view of an outer sleeve illustrating theouter tunnel being tapered.

FIG. 28 a is an upper plan perspective view of an alternative embodimentfor a lysing tip.

FIG. 28 b is an upper view of the lysing tip of the embodiment of FIG.28 a.

FIG. 28 c is a distal view of the embodiment of FIG. 28 a.

FIG. 28 d is side view of the lysing tip of the embodiment of FIG. 28 a.

FIG. 28 e is a perspective view of a side bead of the embodiment of FIG.28 a.

FIG. 28 f is a side view of the annular bead of the embodiment of FIG.28 a.

FIG. 28 g is an upper view of a side bead coupled to lysing rod.

FIG. 28 h is the exploded perspective view of a side bead to show how abead is coupled with a lysing rod and sleeve.

FIG. 28 i is a side perspective view of a middle bead coupled to lysingrod.

FIG. 28 j is a side view of a middle bead.

FIG. 28 k is an upper view of a middle bead coupled to lysing rod.

FIG. 28L is a perspective exploded view of a bead and correspondingsleeve coupled to lysing rod.

FIG. 29 a is an upper plan perspective view of an alternative embodimentfor a lysing tip.

FIG. 29 b is an upper view of the lysing tip of the embodiment of FIG.29 a.

FIG. 29 c is a side view of the embodiment of FIG. 29 a.

FIG. 29 d is side view of the middle bead of the embodiment of FIG. 29a.

FIG. 29 e is a perspective view of the lysing rod and its componentswith 2 beads removed to expose internal components.

FIG. 29 f is a perspective exploded view of an outer annular bead of theembodiment of FIG. 29 a demonstrating how it is coupled with lysing rodand sleeve.

FIG. 30 a is an upper plan perspective view of an alternative embodimentfor a lysing tip.

FIG. 30 b is an upper view of the lysing tip of the embodiment of FIG.30 a.

FIG. 30 c is a side view of the embodiment of FIG. 30 a.

FIG. 30 d is side view of the middle bead of the embodiment of FIG. 30 aand corresponding sleeve coupled to lysing rod.

FIG. 30 e is a perspective view of an outer bead in an uncompressedstate.

FIG. 30 f is a perspective view of an outer bead in a compressed state.

FIG. 30 g is a perspective view of an outer sleeve of the embodiment ofFIG. 30 a.

FIG. 30 h is a side view of an outer bead in an uncompressed state.

FIG. 30 i is a side view of an outer bead in a compressed state.

FIG. 30 j is an upper view of an outer bead in an uncompressed state.

FIG. 30 k is an upper view of an outer bead in a compressed state.

FIG. 31 a is a perspective view of an embodiment of a system fordelivery of a lysing tip through a cannula in a treatment configuration.

FIG. 31 b is a close-up perspective view of the embodiment depicted inFIG. 31 a comprising the middle beads depicted in FIG. 28 a.

FIG. 31 c is a close-up perspective view of the embodiment depicted inFIG. 31 a comprising the middle beads depicted in FIG. 27 a.

FIG. 31 d is a close-up perspective view of the embodiment depicted inFIG. 31 a comprising the middle beads depicted in FIG. 29 a.

FIG. 31 e is a close-up perspective view of the embodiment depicted inFIG. 31 a comprising the middle beads depicted in FIG. 30 a.

FIG. 32 a is a perspective view of an embodiment of a TMT coupled to acannula with actuating rods and canal in the treatment configuration.

FIG. 32 b is a perspective view of the embodiment of FIG. 32 a inbetween the treatment and delivery configurations without canal.

FIG. 32 c is a perspective view of the embodiment of FIG. 32 a in thedelivery configuration without canal.

FIG. 33 a is a perspective view of a TMT comprising an energy barcoupled to a grasping/control instrument with energy conduit visible.

FIG. 33 b is a side view of the embodiment depicted in FIG. 33 a withTMT uncoupled from grasping/control instrument with energy conduitvisible.

FIG. 33 c is a perspective view of a cover to the TMT depicted in FIG.33 a.

FIG. 33 d is a perspective view of the energy bar and members to the TMTdepicted in FIG. 33 a.

FIG. 33 e is a perspective view of a TMT and its associatedgrasping/control instrument and an alternative embodiment of an energyconduit.

FIG. 33 f is a top plan view of the embodiment depicted in FIG. 33 adepicting the energy window tip in a delivery configuration and coupledto a modular instrument tip.

FIG. 34 a is an upper view of a dissector/tissue clamp system in thetreatment/dissection configuration.

FIG. 34 b is an upper view of the dissector/tissue clamp system depictedin FIG. 34 a with jaws in an intermediate configuration.

FIG. 34 c is an upper view of the dissector/tissue clamp system depictedin FIG. 34 a with jaws clamped.

FIG. 34 d is an upper view of the dissector/tissue clamp system depictedin FIG. 34 a in the delivery configuration.

FIG. 34 e is an upper view of the dissector/tissue clamp system depictedin FIG. 34 a with outer cannula removed.

FIG. 34 f is an exploded view of the parts of the tip of the embodimentdepicted in FIG. 34 a.

FIG. 34 g is a rear perspective view of the parts depicted in FIG. 34 fcoupled.

FIG. 34 h is an example of a bipolar embodiment of the system depictedin FIG. 34 a.

FIG. 34 i is an alternative embodiment of the bipolar system depicted inFIG. 34 h.

FIG. 35 a is a perspective view of an alternative embodiment of a systemcomprising a rotatable lysing tip and associated grasping/controlinstrument and cannula.

FIG. 35 b is a perspective view of the embodiment of FIG. 35 a withlysing tip rotated.

FIG. 35 c is a close-up side rear view of the lysing tip of theembodiment of FIG. 35 a with upper jaw removed.

FIG. 35 d is the side view of the support member of the embodiment ofFIG. 35 a showing the upper and lower projections.

FIG. 35 e is a perspective view of the upper jaw of the embodiment ofFIG. 35 a.

FIG. 35 f is a top view of an alternative to the embodiment of FIG. 35 ain a delivery configuration in which the upper and lower protrusions aremoved away from the centerline of the support member.

FIG. 36 a is an alternative embodiment of a lysing tip comprising twoouter protrusions extending from a support member and two inner beadspositioned along a lysing member.

FIG. 36 b is an upper plan view of various components of the lysing tipof the embodiment depicted in FIG. 36 a.

FIG. 36 c is an upper plan view of the lysing tip of the embodimentdepicted in FIG. 36 a.

FIG. 36 d is an upper plan view of certain components of the lysing tipof the embodiment depicted in FIG. 36 a.

FIG. 36 e is a side view of the embodiment depicted in FIG. 36 a.

FIG. 37 a is an alternative embodiment of a lysing tip comprising twobeads that may cover the end tips of the support member.

FIG. 37 b is an upper plan view of certain components of the lysing tipof the embodiment depicted in FIG. 37 a.

FIG. 37 c is an upper plan view of the lysing tip of the embodimentdepicted in FIG. 37 a.

FIG. 37 d is a side view of the side bead of the embodiment depicted inFIG. 37 a , said view being from the inside.

FIG. 37 e is a side view of the side bead of the embodiment depicted inFIG. 37 a , said view being from the outside.

FIG. 38 a is an upper view of a lysing member with associated beads.

FIG. 38 b is an exploded upper view of an alternative embodiment to thelysing tip of FIG. 38 a in proximity to its modular grasping/controldevice.

FIG. 38 c is an upper view of the embodiment of FIG. 38 b in thedelivery configuration.

FIG. 39 a is a perspective view of an embodiment comprising a modulartip further comprising a support member that slides through a slotwithin said modular tip.

FIG. 39 b is an upper view of the embodiment depicted in FIG. 39 a inthe treatment configuration.

FIG. 39 c is an upper view of a midline cross section of the embodimentdepicted in FIG. 39 b in the treatment configuration comprising a pistonengaging and bracing the support member.

FIG. 39 d is an upper view of the embodiment depicted in FIG. 39 a inthe delivery configuration depicting an alternative mechanism to bracethe support member during a surgical procedure.

FIG. 39 e is an upper view of the embodiment depicted in FIG. 39 a inthe delivery configuration depicting an alternative mechanism to fix thesupport member during a surgical procedure.

FIG. 40 is a flow chart illustrating one implementation of a method foran energy feedback loop.

FIG. 41 is a flow chart illustrating one implementation of a method forseparating and modifying tissues.

FIG. 42 is a flow chart illustrating one implementation of a method foraccessing an organ.

FIG. 43 is a flow chart illustrating one implementation of a method forhernia repair.

FIG. 44 is a flow chart illustrating one implementation of a method foraccessing the central nervous system.

FIG. 45 is a flow chart illustrating one implementation of a method forremoving tissue from a peripheral nerve.

FIG. 46 is a flow chart illustrating one implementation of a method forcreating a flap.

FIG. 47 is a flow chart illustrating one implementation of a method forcreating a graft.

FIG. 48 is a flow chart illustrating one implementation of a method forremoving tissue/tumor from an organ.

FIG. 49 is a flow chart illustrating one implementation of a method forremoving an organ.

FIG. 50 is a flow chart illustrating one implementation of a method forremoving scar and/or fibrotic tissue.

FIG. 51 is a flow chart illustrating one implementation of a method fortreatment of apocrine glands.

FIG. 52 is a flow chart illustrating one implementation of a method fortreatment of eccrine glands.

FIG. 53 is a flow chart illustrating one implementation of a method forreduction of hair.

FIG. 54 a is a perspective view of surgical site involving cellulitetreatment.

FIG. 54 b is a perspective view of surgical site involving cellulitetreatment.

FIG. 55 is a flow chart illustrating one implementation of a method fortreatment of cellulite.

FIG. 56 is a flow chart illustrating one implementation of a method forface dissection and/or face lifting.

FIG. 57 is a flow chart illustrating one implementation of a method forneck dissection and/or neck lifting.

FIG. 58 is a flow chart illustrating one implementation of a method fordissection of the brow and/or brow lifting.

FIG. 59 is a flow chart illustrating one implementation of a method forcreating pockets for implants.

FIG. 60 is a flow chart illustrating one implementation of a method forcapsulotomy.

FIG. 61 is a flow chart illustrating one implementation of a method forbody lifting and skin excision.

DETAILED DESCRIPTION

Further details regarding various embodiments will now be provided withreference to the drawings.

FIGS. 1 a-j depict an embodiment of a CDTD 100 comprising a plurality ofprotrusions 101 and recessions 102 positioned in between adjacentprotrusions. In the depicted embodiment, recessions 102 comprise lysingsegments 103 a, 103 b, and 103 c. Thus, a lysing segment is positionedin each of the recessions 102 positioned in-between adjacent protrusions101. In the depicted embodiment, these three lysing segments 103 a, 103b, and 103 c are collectively defined by a lysing member 103. However,other embodiments are contemplated in which separate lysing members maybe used for each of the lysing segments positioned between adjacentprotrusions.

In this embodiment, the lysing member 103 comprises a lysing plate.However, other embodiments are contemplated in which separate lysingmembers may be used for each of the lysing segments 103 a/103 b/103 cpositioned between adjacent protrusions 101.

In the depicted embodiment, the cannulas 131 and 132 may comprise hollowtubes, which may comprise insulating and/or supportive coating(s) and/orcover overlying other conductive materials. The first/inner/devicecannula 131 may be considered a device cannula that is coupled withdevice/lysing tip 110 and may or may not be used with a second/outercannula. The second/outer cannula 132 could be associated with a trocarand may be used primarily for surgical introduction offirst/inner/device cannula 131 into body. In alternative embodiments andimplementations even first/inner/device cannula 131 may be omitted forcertain procedures. With respect to such embodiments, other structuralelements may be added to provide rigidity and/or to assist with deliveryand/or use of the device during a procedure.

It should be understood that in some embodiments or implementations,such devices can be used in connection with only a single cannula asshown in FIG. 1 j . Such an embodiment or implementation may be usefulbecause: (A) the surgeon may not be working in a closed cavity thatrequires insufflation (for example, skin, fat, muscle); (B) it may allowthe manufacture of a larger tip configuration than the smallestcannula's constraining dimensions allowing for larger, thicker, strongercomponents than would otherwise be permitted to fit in the smallervolume or pass through a smaller cross-sectional area, or (C) it mayallow smaller diameter entrance incision/wound as cannulas have athickness component.

Each of the protrusions 101 extends from a common base 105 such that theprotrusions 101 are coupled with one another. In some embodiments, eachof the protrusions 101 is integrally coupled with each of the otherprotrusions 101. Thus, in some embodiments, each of the protrusions maybe defined by base 105. Alternatively, separate protrusions 101 may becoupled with or formed on base 105. A linking member 115 may be anintegral part of or a monolithic component with lysing member 103.Alternatively, linking member 115 could be coupled to the lysing member103. Linking member 115 may be used to facilitate a desired couplingbetween lysing tip 110—which, in the embodiment of FIG. 1 e , comprisesprotrusions 101, recessions 102, lysing member(s) 103 (which maycomprised of lysing segments 103 a/103 b/103 c), linking member 115, andhinges 116/117 that may adhered to or otherwise coupled with linkingmember 115—and one or more elements used to facilitate delivery and/ordeployment of lysing tip 110 through cannulas 131 and/or 132 such asactuation rods 121, 122, 123, and/or 124. In some embodiments, linkingmember 115 may be a separate component from lysing tip 110 and may beused to couple lysing tip 110 to a hinge and/or actuation rod. Linkingmember 115 preferably is at least partially covered and in someembodiments fully covered by an insulating material so that theelectrosurgical energy is delivered to lysing member 103 withoutdelivering electrosurgical energy to the rear of lysing tip 110. Inalternative embodiments, a wire or wires may extend through an insulatoror insulating portion of linking member 115 and connect with aconducting portion of linking member 115 and/or lysing member 103. Thiswire or wires could extend through or along one or both of the actuationrods and/or within the first/inner/device cannula 131 to supplyelectrosurgical energy to linking member 115 from the hand assembly.

In some embodiments and implementations, linking member 115 may benon-conductive and as such hinges 116 and 117 may be electricallycoupled to lysing member 103. Alternatively, hinges 116 and 117 may benon-conductive as well, and in such case, the lysing member 103 may beelectrically coupled to electrosurgical energy source by other meanssuch as wire for example.

Retraction guide 125 is preferably near tip 110 at or near the distalend of one of actuation rods 121/122. In the depicted embodiment,retraction guide 125 is positioned near the distal end of actuation rod122 adjacent to (immediately proximal of) tip 110. In some embodiments,retraction guide 125 may comprise a resilient material, such as aspring, so that it provides a restorative force during retraction of tip110 into cannula 131. Preferably, retraction guide 125 is positioned andconfigured so as to extend from actuation rod 122 laterally by adistance at least approximately equal to, in some embodiments slightlygreater than, the distance one or more of the protrusions 101 thatextend laterally relative to actuation rod 122 in the retracted/foldedconfiguration. In some embodiments, retraction guide 125 may extend inthis direction a distance equal to, or slightly greater than, thelargest protrusion 101 (in embodiments in which each of the protrusionsare not identical and/or do not project an equal distance).

In the depicted embodiment, protrusions 101 are fixed with respect tobase 105 and the rest of lysing tip 110. In this embodiment, protrusions101 are fixed three-dimensionally with respect to base 105 and the restof lysing tip 110. In other embodiments discussed later, protrusions 101may not be coupled to a common base. Similarly, in other embodimentsdiscussed later, protrusions 101 may be movable rather than fixedthree-dimensionally. For example, in some embodiments, protrusions 101may be rotatable with respect to a lysing member, a base, and/or anotherportion of lysing tip 110.

System 100 may be configured to allow for repositioning of lysing tip110 between a delivery configuration and a treatment configuration. Inthe delivery configuration, protrusions 101 may be configured to extendin a direction that is at least substantially perpendicular to thecannula axis, and lysing tip 110 may be configured to extend in adirection that is at least substantially parallel to the cannula axis.In other embodiments, lysing tip 110 may be configured to extend at anacute angle relative to the cannula axis so long as the axis of lysingtip 110 fits within the lumen of the cannula such as shown in FIG. 11 fas an example. In addition, in the depicted embodiment, lysing tip 110may be configured such that an energy delivery side of lysing tip 110 infront of protrusions 101 and recessions 102, which energy delivery sidewill ultimately deliver electrosurgical energy for dissecting tissue,faces an interior surface of a lumen of first/inner/device cannula 131through which lysing tip 110 is delivered. Following delivery of lysingtip 110 through a distal end of first/inner/device cannula 131 and/orsecond/outer cannula 132, system 100 may be configured to repositionlysing tip 110 to the treatment configuration in which the energydelivery side extends at least substantially perpendicular to thecannula axis.

Lysing tip 110 may comprise an orientational-deployment side oppositefrom the energy delivery side. The orientational-deployment side oflysing tip 110 may be configured to allow lysing tip 110 to berepositioned between the delivery configuration and the treatmentconfiguration described above. A deployment assembly may be coupled withthe orientational-deployment side of lysing tip 110. This deploymentassembly may be configured to allow for selective repositioning betweenthe delivery and treatment configurations. In the depicted embodiment,the deployment assembly may comprise linking member 115 and one or morepivot members, such as pivot members 116 and 117. Pivot members 116and/or 117 may comprise various elements configured to allow forselective pivoting, rotation, and/or angulation of lysing tip 110, suchas joints, ball pivots, hinges, pins, groove/slot pairs, etc.

Pivot members 116 and 117 may be coupled with linking member 115 at oneend and may be coupled with distal (to the surgeon) portions 121 and 122of actuation rods, respectively. Thus, upon advancing one or both ofproximal actuation rods 123 and 124, lysing tip 110 may be advanced inits delivery configuration down one or more cannulas, such asfirst/inner/device cannula 131 and/or second/outer cannula 132. In someembodiments, appropriate wires or other transmission lines for deliveryof electrosurgical energy may be positioned to extend adjacent and/orthrough one or more of the various actuation rods. Alternatively, insome embodiments, electrosurgical energy may be delivered directlythrough one or more actuation rods. In some embodiments, wires or othertransmission lines for delivery of electrosurgical energy may instead,or additionally, extend though other regions of lumens offirst/inner/device cannula 131 and/or second/outer cannula 132.Actuation rods 121, 122, 123 and/or 124 may comprise any suitablematerial depending on whether electrosurgical energy is being deliveredthrough them. For example, a metal or other conductive material may beused if electrosurgical energy is to be delivered through the actuationrods, or a plastic or other insulating material may be used ifelectrosurgical energy is to be delivered through separate wiring orother suitable transmission lines. Actuation rods may be divided intomore segments, with or without pivots, than proximal or distal, forexample, 3 segments. In some embodiments, actuation rods may beinsulated with a non-conductive material but may have a conductive corefor delivery of electrosurgical energy.

In this embodiment, spot coagulator (“SC”) is comprised of SC shaft 142and SC tip 141 may be seen in the deployed view. SC shaft 142 may becomprised of a metal insulated with a non-conductor. In the depictedembodiment, SC shaft 142 is slidably coupled to the first/inner/devicecannula 131. The more distal end of the SC is the SC tip 141 and themore proximal (toward the surgeon) end of the SC is SC shaft 142. Inthis depicted embodiment the SC tip 141 extends from the SC shaft 142and is conductive and not insulated along at least a portion of the tip.In some embodiments, the entire tip may be conductive. A spot coagulatormay be helpful by allowing the surgeon not to exchange other instrumentsduring the operative procedure to stem bleeding blood vessel(s); it maybe beneficial during some surgical procedures to have spot coagulatorcoagulation capabilities within the same instrument. In the depictedembodiment the SC tip 141 may be restricted to 25 mm protrusion beyondthe distalmost portion of lysing tip 110, which may comprise one end ofthe protrusions 101 on lysing tip 110. In various contemplatedembodiments, a bend in the SC shaft 142 and/or size mismatch and/ortether, etc., may also be used to limit the distance SC tip 141 mayprotrude. In other contemplated embodiments, no elements may restrictthe working movement range of the SC shaft 142. The SC shaft 142 mayderive its electrical energy from separate wiring and/or parasitizationoff of one or more of the actuation rods. In the depicted embodiment, SCshaft 142 may comprise one or more non-insulated area(s) that may bebrought into an actuation rod or other energetic source within thefirst/inner/device cannula 131. An implementation using the depictedembodiment may involve pushing distally SC either directly or indirectlyon the SC shaft 142 distally (possibly via through handle assembly 160).Electrosurgical energy, such as suitable electrosurgical waveform, maybe delivered when the electrosurgical generator is activated, via thehandle assembly 160 into the SC shaft 142 and thereupon to SC tip 141and then into target tissue. In the depicted embodiment SC shaft 142 maycomprise stainless steel and may be round in cross-section. Also in thedepicted embodiment, the exterior of the SC shaft 142 may be insulated.The electrical insulator may comprise, for example, porcelain, ceramics,glass-ceramics, plastics, various halogenated carbon molecules,polytetrafluoroethylene, carbon, graphite, and graphite-fiberglasscomposites and the like. In some embodiments, the conductive materialmay comprise: steel, nickel, alloys, palladium, gold, tungsten, silver,copper, platinum and/or any other conductive metal that does not giveoff toxic residua at operating temperatures. In other contemplatedembodiments, the conductive material may comprise cermets and the like.In the depicted embodiment, SC tip 141 is shaped like a sphere. In otherembodiments, the SC tip may be shaped like the frustum of a cone,pyramid, polyhedron, ellipsoid, as well as a wide variety of geometricshapes. In some embodiments, SC shaft 142 may be oval, flat, rectangularor geometric in cross-section or substantially flattened. In alternativeembodiments, SC tip 141 may be pointed, bullet shaped, or geometric incross section; more angulate and/or pointed tips may disperse electricalenergy more readily and allow greater precision than larger, morerounded tip designs. In the depicted embodiments of the SC shaft 142,the electrical insulator may comprise polytetrafluoroethylene. Inalternative embodiments the electrical insulator may comprise, forexample, polyether etherketone and/or polysulfone and/or anotherelectrically nonconductive polymers (with thermal stability in theoperating range) and/or materials that are both electricallynon-conductive and of low thermal conductivity. In contemplatedembodiments the electrical insulator may comprise, for example,porcelain, ceramics, glass-ceramics, plastics, various halogenatedcarbon molecules, polytetrafluoroethylene, carbon, graphite, andgraphite-fiberglass composites and the like. Although the depictedembodiment shows a manually deployed SC, other contemplated embodimentsmay allow deployment to be (including but not limited to): motorizedand/or spring activated and/or screw driven and/or ratchet style and/orcog style and/or pneumatic and/or hydraulic, etc. In the depictedembodiment, the SC tip 141 and SC shaft 142 together may measure about,2 mm in diameter and be of a suitable length to match the given systemincluding the handle assembly. In some embodiments, the insulationthickness may range from about 0.1 mm to 3 mm. Embodiments arecontemplated wherein sizes of about one-fifth to about five times thesedimensions may have possible uses. It is also contemplated in someveterinary embodiments tip sizes of about one-tenth to 20 times theaforementioned dimensions having possible uses.

System 100 comprises two separate cannulas, namely, a first/inner/devicecannula 131 which preferably comprises a lumen of sufficient diameter toallow folded lysing tip 110 (in a delivery configuration) to bepositioned within the lumen of first/inner/device cannula 131, and asecond/outer cannula 132, which may have a larger cross-sectionaldiameter; the first/inner/device cannula 131 may be delivered withinsecond/outer cannula 132.

In some embodiments and implementations, lysing tip 110 may beconfigured such that its protrusions 101 and/or another portion oflysing tip 110 are too large to fit within the lumen offirst/inner/device cannula 131, even in the delivery configuration.Thus, lysing tip 110 in its delivery configuration may be positionedjust outside (immediately distal) of first/inner/device cannula 131 andwithin second cannula 132 during delivery and retraction. Any of theembodiments described herein may be configured such that the tip 110cannot be fully received within first/inner/device cannula 131. Thisembodiment may be useful because it permits the tip to be as large aspossible given the dimension constraints of the second/outer cannula andnot the first/inner/device cannula thus reducing the expense of furtherminiaturizing and/or allows for thicker/stronger components.

By providing two co-axial cannulas, proximal actuation rods 123 and 124may be prevented, or at least substantially prevented, from inordinatebending and/or being separated from one another or otherwise system 100may be configured to maintain better control over lysing tip 110 duringdeployment. Thus, preferably, actuation rods 123 and 124 are alsodelivered through first/inner/device cannula 131. Some embodiments mayfurther comprise one or more additional joints and/or pivot memberspositioned proximally relative to pivot members 116 and 117. Forexample, some such embodiments may comprise hinges and/or pivot membersthat are positioned within one or both of proximal actuation rods123/124, and one or both distal actuation rods 121/122 such as hinges127 and 128. Hinges 127/128 may allow for one or both of distalactuation rods 121/122 to be pivoted/rotated in a desired direction oncehinges 127/128 have exited or are approximately coincident with or nearthe terminal end of first/inner/device cannula 131.

In the depicted embodiment, hinge 127 may be actuated by providingactuating means comprising two cords 129 a and 129 b that extend fromactuation rod 121. Cords 129 a and 129 b may be coupled with lysing tip110 such that forces from cords 129 a and 129 b may be transferred tolysing tip 110 to result in pivoting of hinge 127. By selectivelypulling on one of the cords 129 a and 129 b, tip 110 may be rotated in adesired direction and by selectively pulling on another of the cords 129a and 129 b, tip 110 may be rotated in a different desired direction. Ofcourse, any number of cords may be used to fine tune the pivotability oflysing tip 110 as desired. Cords 129 a and 129 b may comprise anysuitable material, such as wiring, plastic, metal, string, biopolymer,etc. Cord attachment areas 121 u and 121L on distal actuation rod 121may be used to affix cords 129 a and 129 b. Such cord attachment areasmay comprise an opening for insertion of the cord which may include aplug or weld to secure the cord. In other embodiments, the cordattachment area 121 u or 121L may comprise a weld against the surface ofdistal actuation rod 121.

The deployment assembly of system 100 may further comprise a handleassembly 160 that may be used to selectively deploy lysing tip 110 andcontrol various aspects of its delivery and/or use during surgery.Handle assembly 160 comprises a body 161 coupled with a pistol grip 162.First/inner/device cannula 131 may extend from and be coupled withhandle assembly 160. A rocker assembly 165 or another such control meansmay be provided for actuation of various features/functions/elements insystem 100. For example, rocker assembly 165 may be coupled with cords126 a/126 b and 129 a/129 b such that, upon pressing rocker assembly 165along a top portion of the assembly, a first cord or set of cords 126 band 129 b may be pulled causing the tip 110 to rotate upwards.Similarly, rocker assembly 165 may be further configured such that, uponpressing rocker assembly 165 along a bottom portion of the assembly theother cord or set of cords 126 a and 129 a may be pulled causing the tipto rotate downwards. Upon pushing one of cords 126 a/129 a, the other ofcords 126 b/129 b may be moved in an opposite direction, since pushingone end of rocker assembly 165 may result in an opposite movement of theopposite end of rocker assembly 165. In this manner, lysing tip 110 maybe selectively moved in one direction or another as desired. In analternative embodiment, a more rigid cord or wire may be used to push anactuation rod into a desired position.

In this particular embodiment, hinges 127 and 128 may be positionedbetween or at the ends of actuation rods 121/123 and/or 122/124,respectively, and may allow for rotation of lysing tip 110 above and/orbelow the cross-sectional profile of first/inner/device cannula 131.Alternatively, hinges 127 and 128 or other means for facilitatingmovement of the tip outside of the cross-sectional profile of thefirst/inner/device cannula 131 may be positioned along the length of oneor more actuation rods such as 123 or 124 in which case distal actuationrods may be omitted.

An electrosurgical actuation button 167 may be provided, which a surgeonmay use to initiate transmission of electrosurgical energy to lysing tip110. More particularly, electrosurgical actuation button 167 may be usedto initiate transmission of electrosurgical cutting or blended energy tolysing member/plate 103. Button 167 may be positioned on rocker assembly165 if desired, as shown in FIG. 1 i . Pressing or otherwise actuationof button 167 may result in delivery of such energy from anelectrosurgical generator coupled with handle assembly 160. Handleassembly 160 may also be used in connection with any of the otherembodiments disclosed herein.

Lysing member 103 is shown removed from the rest of lysing tip 110 inFIGS. 1 g and 1 h . As shown in FIG. 1 h , lysing member 103 may beconfigured to define three separate lysing segments, as shown in thefigure. In other embodiments, however, lysing member 103 may beseparated into three distinct and separated segments. This may be usefulfor certain applications, such as, for example, for embodiments usingbipolar electrosurgical energy, such that each separate segment may beactivated with electrosurgical energy separately.

Handle assembly 160 may further comprise one or more other actuationcontrols. For example, as also shown in FIG. 1 i , handle assembly 160may comprise a first actuation rod control 168 and a second actuationrod control 169. In some embodiments, one or both of first and secondactuation rod controls 168 and 169 may comprise a ratchet to allow asurgeon to more precisely control the distance with which lysing tip 110is extended and/or allow for locking lysing tip 110 in place withrespect to first/inner/device cannula 131 and/or second/outer cannula132. In some embodiments, one or both of first and second actuation rodcontrols 168 and 169 may have a manual control element, such as a fingercontrol element as shown, or another grip, button, trigger, or othersuitable control element. First and second actuation rod controls168/169 may be directly or indirectly connected to proximal actuationrods 123/124 to effect movement and positioning of lysing tip 110.

In some embodiments, handle assembly 160 may be configured to berotatable with respect to the first/inner/device cannula 131 and/or thesecond/outer cannula 132 such that the lysing tip 110 may be selectivelyrotated within a patient's body. In other words, system 100 may beconfigured such that some or all of the elements of the system otherthan first/inner/device cannula 131 and/or second/outer cannula 132, orin some embodiments some or all elements within first/inner/devicecannula 131 and/or second/outer cannula 132 (such as, in someembodiments, just lysing tip 110), may be selectively rotated fromhandle assembly 160 to allow lysing tip 110 to be selectively rotated asneeded during surgery.

It should be understood that handle assembly 160 may be used inconnection with one or more of the other systems disclosed herein. Ofcourse, those of ordinary skill in the art will appreciate that anyother handle assembly, gun, or other available control mechanism mayalso be used, as desired.

Some embodiments may be configured such that lysing tip 110 is notaligned with the axis of cannulas 131 or 132 in the deliveryconfiguration. More particularly the axis of lysing tip 110 may bepositioned at an acute angle with respect to the axis of cannulas 131 or132. In other embodiments, lysing tip 110 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 110 fits within the lumen and/or lumens of one and/or bothcannulas.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 131 may vary as for example,as shown in FIGS. 14 k and 14L. In other words, the lysing tip 110 inthe axial deployment configuration may be unable to be received withincannula 131 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula of two delivery cannulas as shown in FIG. 14 k .In embodiments comprising two cannulas, this may be useful because ifthe lysing tip does not require substantial protection and can remainoutside the inner cannula's lumen, then the critical dimensions of thelysing tip can correspond to the larger diameter outer cannula asopposed to being limited to the smaller dimensions of the inner/devicecannula. In embodiments comprising a single cannula, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip in its axial/delivery configuration onlyneed to correspond to the size of the entrance incision. With respect tosuch embodiments, the single cannula may primarily serve to protect andstabilize the control rods and provide rigidity to the assembly. Suchembodiments may be useful for cosmetic procedures within the skin, forexample, but not limited to, for face lifting and/or cellulitetreatment.

Although in the embodiments previously depicted, the protrusionstypically extended along an axis of the cannula and were parallel to oneanother along the lysing tip, other embodiments are contemplated inwhich non-axial protrusions may instead be provided. In some suchembodiments such as those depicted in FIGS. 26 a /26 b, for example, thetwo outermost protrusions/beads may extend at an angle of between about60 degree and 90 degrees relative to each other. In some embodiments,adjacent beads/protrusions may be configured to extend relative to eachother at an angle between about 20 to 40 degrees. It is contemplatedthat it may be desirable for some implementations and embodiments toprovide, non-axial tips extending in a direction or directions fallingwithin this range in order to, for example, allow a surgeon toeffectively perform both a to and fro, and a side-to-side (“windshieldwiper”) motion using the CDTD. Such side or non-axial protrusions may beuseful to enable a surgeon to avoid entangling the dissector in tissueduring one or both such motions.

FIGS. 2 a-2 e depict an alternative embodiment of a CDTD system 200comprising a plurality of protrusions 201 and recessions 202 positionedin between adjacent protrusions. In the depicted embodiment, a lysingmember 203 (comprised of lysing segments 203 a/203 b/203 c) ispositioned so as to extend in recessions 202 and define a plurality oflysing segments. Thus, a lysing segment 203 a/203 b/203 c is positionedin each of the recessions 202 positioned in-between adjacent protrusions201. Lysing member 203 is further electrically coupled to linking member215. System 200 further comprises first/inner/device cannula 231 andsecond/outer cannula 232, the first or both which may be used to deliverlysing tip 210, as previously mentioned.

Some embodiments may comprise an energy window 206 located proximally toprotrusions 201. In the depicted embodiment, energy window system 206may comprise electrode termini 206 a/206 b/206 c/206 d which may besupplied energy from an energy source via conduits (not shown) that maycomprise, for example, wires and/or fiber optic filaments and/or thelike. Energy window 206 may be configured in any manner to accommodateany energy modality, including, but not limited to, laser, intense pulselight, resistive heating, radiant heat, thermochromic, ultrasound,mechanical, and/or microwave.

In some embodiments, each of the various electrode termini 206 a/b/c/dmay comprise separate elements each of which may be coupled with lysingtip 210. In such embodiments, it may be preferred to have an electricalconduit such as a wire coupled along tip 210 between each adjacenttermini 206 a/b/c/d. Alternatively, a ribbon and/or band or othersuitable coupling element (not shown) may define or contain each of thevarious termini. Such coupling elements may be coupled with lysing tip210 in any suitable manner.

System 200 only differs from system 100 in that it lacks a spotcoagulator and possesses an energy window(s).

FIGS. 3 a-3 e depict another alternative embodiment of a CDTD system 300comprising a plurality of protrusions 301 and recessions 302 positionedin between adjacent protrusions 301. In the depicted embodiment, alysing member 303, and its associated lysing segments 303 a/303 b/303 c,is positioned so as to extend in recessions 302 and define a pluralityof lysing segments. Thus, a lysing segment is positioned in each of therecessions 302 positioned in-between adjacent protrusions 301. System300 further comprises first/inner/device cannula 331 and may comprisesecond/outer cannula 332, which may be used to deliver lysing tip 310,as previously mentioned.

System 300 only differs from system 100 in that it possessesunitary/unhinged actuation rods, a canal, and rotational stop means andthat system 300 lacks a spot coagulator.

System 300 may comprise canal(s) 304 which may be positioned to supplyone or more fluids to the surgical site around or near lysing tip 310via a port located adjacent to the internal device cannula and/or lysingtip (show in FIG. 3 a only). Canal 304 may be configured to be extendedand withdrawn as needed. In alternative embodiments, other fluids thatmay pass down canal 304 may include, but not be limited to, coldnitrogen gas, fluorocarbons, etc., which might cool and/or freeze tissueto alter it in a desired fashion.

Most notably, system 300 comprises means for fixing the rotationalorientation of lysing tip 310 with respect to first/inner/device cannula331. In some embodiments the rotational fixing means may also provideproximal support to lysing tip 310 during a surgical procedure. Moreparticularly, in the depicted embodiment, this rotational fixing meanscomprises opposing slots 333 a and 333 b formed in the distal end offirst/inner/device cannula 331, which slots are sized, shaped, andconfigured to receive at least a portion of actuation rods 323/324 whendeployed distally. Other examples of rotational fixing means 333 a/333 binclude hooks, catches, etc. In addition, in another example of arotational fixing means, corresponding features on the deployment sideof lysing tip 310 may engage the distal end or special features designedin the distal end of first/inner/device cannula 331. In someembodiments, such fixing may also provide direct support restrictingproximal movement. In alternative embodiments, rotational fixing meansmay comprise grooves on the inside of the cannula lumen of raised railsor channels in the material from which cannulas are made; said groovesengage one or both actuation rods for support.

FIG. 3 d shows how portions of the actuation rods 323/324 engagerotational fixing means 333 a/333 b.

FIG. 3 a is an isometric view depicting how, in the treatmentconfiguration, lysing tip 310 extends, at both opposing ends, beyond thecross-sectional profile of first/inner/device cannula 331. Also, in thisparticular embodiment, lysing tip 310 is coupled with actuation rods323/324 at points that are greater than the inner diameter of thecross-sectional profile of first/inner/device cannula 331 in thetreatment configuration.

Retraction guide 325 is preferably near tip 310 at or near the distalend of one of actuation rods 323/324. In the depicted embodiment,retraction guide 325 is positioned near the distal end of actuation rod324 adjacent to (immediately proximal of) lysing tip 310. In someembodiments, retraction guide 325 may comprise a spring and/or be madeup of a resilient material so that it provides a restorative forceduring retraction of lysing tip 310 into first/inner/device cannula 331.Preferably retraction guide 325 may be shaped to (A) if made of anon-resilient material, have a sufficient slope so that the edge closestto the cannula does not have its proximal movement impeded but rathercause a lateral movement of the actuation rods and tip toward theopposite side of the cannula or (B) if made of a resilient material,upon contacting the distal end of the cannula, retraction guide 325deforms in a manner that permits proximal movement and then provides arestorative force that guides the lateral movement of the actuation rodsand tip to the opposite side of the cannula. Preferably, retractionguide 325 is positioned and configured so as to extend from actuationrod 324 laterally by a distance at least approximately equal to, in someembodiments slightly greater than, the distance one or more of theprotrusions 301 that extend laterally relative to actuation rod 324 inthe retracted/folded configuration. In some embodiments, retractionguide 325 may extend in this direction a distance equal to, or slightlygreater than, the largest protrusion 301 (in embodiments in which eachof the protrusions are not identical and/or do not project an equaldistance).

In the depicted embodiment, each of the protrusions 301 extends from acommon base 305 such that the protrusions 301 are coupled with oneanother. In some embodiments, each of the protrusions 301 is integrallycoupled with each of the other protrusions 301. Linking member 315 maybe coupled to base 305 and/or lysing member 303.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 331 may vary as for example,as shown in FIGS. 14 k and 14L. In other words, the lysing tip 310 inthe axial deployment configuration may be unable to be received withincannula 331 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula of two delivery cannulas as shown in FIG. 14 k .In embodiments comprising two cannulas, this may be useful because ifthe lysing tip does not require substantial protection and can remainoutside the inner cannula's lumen, then the critical dimensions of thelysing tip can correspond to the larger diameter outer cannula asopposed to being limited to the smaller dimensions of the inner/devicecannula. In embodiments comprising a single cannula, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip in its axial/delivery configuration onlyneed to correspond to the size of the entrance incision required for acertain procedure. For example, plastic surgeons may usually attempt tominimize scarring with minimum entrance incision widths, thus, intreating cellulite, the width of the entrance incision and lysing tipprofile using embodiments contemplated herein may be 3 to 6 mm. Withrespect to such embodiments, the single cannula may primarily serve toprotect and stabilize the control rods and provide rigidity to theassembly. Such embodiments may be useful for cosmetic procedures withinthe skin, for example, but not limited to, for face lifting and/orcellulite treatment.

In the depicted embodiment, 347 represents an antenna configured todeliver a signal to a receiver unit. In some embodiments, antenna 347may comprise radiofrequency identification (RFID) TAG. In someembodiments the RFID tag may comprise an RFID transponder. In otherembodiments the RFID tag may comprise a passive tag. It should beunderstood that antenna 347 is not depicted in every one of the otherfigures; any of the embodiments described herein may comprise one ormore such elements. Other embodiments may comprise one or more antennaon any other suitable location on the embodiment, including but notlimited to on the protrusions or otherwise on the tip, and on the shaft.In embodiments in which antenna 347 comprises an RFID transponder, theRFID transponder may comprise a microchip, such as a microchip having arewritable memory. In some embodiments, the tag may measure less than afew millimeters. In some embodiments a reader may generate analternating electromagnetic field which activates the RFID transponderand data may be sent via frequency modulation. In an embodiment, theposition of the RFID tag or other antenna may be determined by analternating electromagnetic field in the ultra-high frequency range. Theposition may be related to a 3 dimensional mapping of the subject. In anembodiment the reader may generate an alternating electromagnetic field.In some such embodiments, the alternating electromagnetic field may bein the shortwave (13.56 MHz) or UHF (865-869 MHz) frequency. Examples ofpotentially useful systems and methods for mapping/tracking a surgicalinstrument in relation to a patient's body may be found in U.S. PatentApplication Publication No. 2007/0225550 titled “System and Method for3-D Tracking of Surgical Instrument in Relation to Patient Body”, whichis hereby incorporated by reference in its entirety.

In some embodiments, a transmission unit may be provided that maygenerate a high-frequency electromagnetic field configured to bereceived by an antenna of the RFID tag or another antenna. The antennamay be configured to create an inductive current from theelectromagnetic field. This current may activate a circuit of the tag,which may result in transmission of electromagnetic radiation from thetag. In some embodiments, this may be accomplished by modulation of thefield created by the transmission unit. The frequency of theelectromagnetic radiation emitted by the tag may be distinct from theradiation emitted from the transmission unit. In this manner, it may bepossible to identify and distinguish the two signals. In someembodiments, the frequency of the signal from the tag may lie within arange of the frequency of the radiation emitted from the transmissionunit. Additional details regarding RFID technology that may be useful inconnection with one or more embodiments discussed herein may be foundin, for example, U.S. Patent Application Publication No. 2009/0281419titled “System for Determining the Position of a Medical Instrument,”the entire contents of which are incorporated herein by specificreference.

In other embodiments, antenna 347 may comprise a Bluetooth antenna. Insuch embodiments, multiple corresponding Bluetooth receivers at knownlocations may be configured to sense signal strengths from the Bluetoothantenna 347 and triangulate such data in order to localize the signalfrom the Bluetooth antenna 347 and thereby locate the lysing tip withina patient's body. Other embodiments may be configured to useangle-based, electronic localization techniques and equipment in orderto locate the antenna 347. Some such embodiments may comprise use ofdirectional antennas, which may be useful to increase the accuracy ofthe localization. Still other embodiments may comprise use of othertypes of hardware and/or signals that may be useful for localization,such as WIFI and cellular signals, for example.

One or more receiver units may be set up to receive the signal from thetag. By evaluating, for example, the strength of the signal at variousreceiver units, the distances from the various receiver units may bedetermined. By so determining such distances, a precise location of thelysing tip relative to a patient and/or a particular organ or othersurgical site on the patient may be determined. In some embodiments, adisplay screen with appropriate software may be coupled with the RFID orother localization technology to allow a surgeon to visualize at leastan approximate location of the tag/antenna, and therefore the lysingtip, relative to the patient's body.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 348 may befurther configured with one or more RFID tags. As such, data from theone or more sensors may be paired or otherwise used in connection withdata from the one or more RFID tags or other antennas. For example, someembodiments may be configured to provide information to a surgeonregarding one or more locations on the body from which one or moresensor readings were obtained. In some embodiments, temperature sensorsmay include thermistors and/or thermocouples. To further illustrateusing another example, information regarding tissue temperature may becombined with a location from which such tissue temperature(s) weretaken. In this manner, a surgeon may be provided with specificinformation regarding which locations within a patient's body havealready been treated in an effective manner and thus which locationsneed not receive further treatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 348 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis.

Some embodiments may be configured such that lysing tip 310 is notaligned with the axis of cannulas 331 or 332 in the deliveryconfiguration. More particularly the axis of lysing tip 310 may bepositioned at an acute angle with respect to the axis of cannulas 331 or332. In other embodiments, lysing tip 310 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 310 fits within the lumen and/or lumens of one and/or bothcannulas.

FIGS. 4 a-4 h depict an alternative embodiment of a CDTD system 400comprising a plurality of protrusions 401 and recessions 402 positionedin between adjacent protrusions. In the depicted embodiment, a lysingmember 403, comprised of lysing segments 403 a/403 b, is positioned soas to extend in recessions 402 and define a plurality of lysingsegments. Thus, a lysing segment 403 a/403 b is positioned in each ofthe recessions 402 positioned in-between adjacent protrusions 401.System 400 further comprises first/inner/device cannula 431 andsecond/outer cannula 432, the first or both which may be used to deliverlysing tip 410, as previously mentioned.

System 400 differs from system 100 in that it lacks a spot coagulator,is configured for bipolar electrosurgical energy delivery, has 3protrusions and 2 lysing segments, and has electrically isolated linkingmembers 415 a/415 b.

An external power cord may bring electrosurgical energy from anelectrosurgical generator to a hand assembly 160, such as thatillustrated in FIG. 1 i , (which is electrically connected) to proximalactuation rods 423/424 which are physically and electrically via contactcoupled to distal actuation rods 421/422 and thus to linking members 415a/415 b (via pivot members 416/417) and thus to their respectiveelectrically conductive lysing segments 403 a/403 b, mounted in therecessions 402 in between protrusions, such as protrusions 401. Forexample, electrosurgical current (comprised of alternating currentadjusted to perform certain functions) may flow from electrosurgicalgenerator via proximal actuation rod 423 to distal actuation rod 421 toits physically-connected/electrically-coupled/respective linking member415 a and thus to itsphysically-connected/electrically-coupled/respective electricallyconductive lysing segment 403 a. The electrosurgical current may thentravel into the adjacent/target tissue of the patient via lysing segment403 a and then back into lysing segment 403 b and may then return to theelectrosurgical generator via linking member 415 b via distal actuationrod 422 via proximal actuation rod 424. By virtue of the linking members415 a/415 b being separated and/or insulated from each other, thecurrent may not short circuit within lysing tip 410. Retraction guide425 is preferably near tip 410 at or near the distal end of one ofactuation rods 421/422.

The tip shown in this embodiment has three relative protrusions 401,lysing member 403 (and associated lysing segments 403 a/403 b, pointingalong the main axis of the CDTD in treatment mode. In other embodiments,the bipolar CDTD lysing tip 410 may have one or more non-axialprotrusions and one or more non-axial relative recessions. In someembodiments, the tip may have between 3 and 100 axial and/or non-axialprotrusions and/or relative recessions. It should be understood that thenumber of protrusions need not match the number of lysing elements orrecessions. In some embodiments, lysing elements may be located at thetermini of conductive elements. In some embodiments, lysing elements mayalso be made partially or completely of a cermet material. In anembodiment, the modular bipolar CDTD tip 410 may measure about 12 to 15mm in width and/or about 3 mm in thickness. Embodiments are contemplatedwherein sizes of about one-fifth to about five times these dimensionsmay have possible uses. It is also contemplated, for example in someveterinary embodiments, tip sizes of about one-tenth to 20 times theaforementioned dimensions may have possible uses. In some embodiments,wherein electrical insulation and/or polymeric insulating coating ispresent on such parts, for example, but not limited to, distal andproximal actuation rods and linking member portions 415 a/415 b, suchinsulation may measure about 0.5 mm in thickness; in some contemplatedembodiments, the insulation thickness may range from 0.01 mm to 3 mm. Inother contemplated embodiments, electroconductive leads may course froman electrosurgical generator via first/inner/device cannula 431 toenergize various lysing elements located in bipolar CDTD tip 410. Insome embodiments leads may comprise wires and/or conductive conduits.

FIG. 4 g is a posterior elevated perspective view of the two bipolarlysing segments of the embodiment depicted in FIG. 4 a . In thisembodiment, lysing element 403 may be comprised of even numbers ofoppositely charged (when activated) individual lysing segments 403 a/403b. In this embodiment, individual bipolar CDTD lysing segments 403 a/403b may comprise surgical grade stainless steel positioned within alland/or a portion of one or more pieces of ceramic and/or other thermallyresistant, non-conductive housing. In some embodiments, one or moreindividual lysing elements may comprise electroconductive materialsincluding but not limited to cermets, steel, nickel, alloys, palladium,gold, tungsten, titanium, silver, copper, and/or platinum. In thedepicted embodiment, the lysing elements may measure about 2 mm inlength, and about 0.5 mm in thickness/diameter. In the depictedembodiment, the axial lysing elements are concave and crescentic inshape. However, in other contemplated embodiments lysing elements maycomprise straight and/or convex and/or a variety of shapes.

In some contemplated embodiments there need not be equal numbers ofoppositely signed and/or charged individual lysing elements, forexample, there may be 3 positive and 2 negative individual lysingelements. Uniformity of flux on activation may be achieved by modifyingthe size and/or position of lysing elements with respect to each otheramong other methods known in the art.

The relative static permittivity of some ceramics may range from about 5to 10; this may cause some leakage of current in an undesirable pathbetween closely approximated opposing electrodes during activation. Useof other materials, for example, those having over of relative staticpermittivities of 5 may undesirably alter the resultant plasma field.The relative static permittivity of the intervening materials housingthe opposing electrodes may be enhanced by coating and/or surroundingand/or injection molding thermoresistant polymers of a low relativestatic permittivity into the housing and/or around one or more portionsof bipolar lysing segments 403 a/403 b to reduce the effective staticpermittivity of the tip. In an embodiment, the thermoresistant polymerof low relative static permittivity 2.1 may be polytetrafluoroethylene.In other contemplated embodiments, thermoresistant polymers may includepolyether etherketone (@3.3) and/or polysulfone (@3.1) and the like maybe useful.

In the depicted embodiments, the electrical insulator comprisespolytetrafluoroethylene. In other contemplated embodiments, theelectrical insulator may comprise an electrically nonconductive polymerwith a high melting temperature. In some embodiments, the nonconductivepolymer may comprise for example, polyether etherketone and/orpolysulfone, etc. In other contemplated embodiments, the electricalinsulator may comprise an electrically nonconductive and/or thermallynonconductive polymer.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 431 may vary as for example,as shown in FIGS. 14 k and 14L. In other words, the lysing tip 410 inthe axial deployment configuration may be unable to be received withincannula 431 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula of two delivery cannulas as shown in FIG. 14 k .In embodiments comprising two cannulas, this may be useful because ifthe lysing tip does not require substantial protection and can remainoutside the inner cannula's lumen, then the critical dimensions of thelysing tip can correspond to the larger diameter outer cannula asopposed to being limited to the smaller dimensions of the inner/devicecannula. In embodiments comprising a single cannula, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip in its axial/delivery configuration onlyneed to correspond to the size of the entrance incision. With respect tosuch embodiments, the single cannula may primarily serve to protect andstabilize the control rods and provide rigidity to the assembly. Suchembodiments may be useful for cosmetic procedures within the skin, forexample, but not limited to, for face lifting and/or cellulitetreatment.

As of the year 2000, the bipolar mode had traditionally been usedprimarily for coagulation (reference: “The Biomedical EngineeringHandbook, Electrosurgical Devices” J Eggleston, W Maltzahn, Ch 81, CRCPress 2000). However, more recent modifications to bipolarelectrosurgical outputs may have facilitated the use of bipolar cuttinginstruments (reference: ValleyLab, Hotline, vol. 4, issue 4 pg. 1),examples of such outputs may include Macrobipolar settings (Reference:ValleyLab ForceTriad Users Guide 2006, chapter/sections: 9-13, 9-16,9-24).

Some embodiments may be configured such that lysing tip 410 is notaligned with the axis of cannulas 431 or 432 in the deliveryconfiguration. More particularly the axis of lysing tip 410 may bepositioned at an acute angle with respect to the axis of cannulas 431 or432. In other embodiments, lysing tip 410 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 410 fits within the lumen and/or lumens of one and/or bothcannulas.

FIGS. 5 a-5 e depict still another embodiment of a CDTD system 500. FIG.5 a depicts system 500 in a treatment configuration. System 500 againcomprises a plurality of protrusions 501 and recessions 502 positionedin between adjacent protrusions 501. In the depicted embodiment, alysing member 503, comprised of lysing segments 503 a/503 b/503 c, ispositioned so as to extend in recessions 502 and define a plurality oflysing segments. Thus, a lysing segment is positioned in each of therecessions 502 positioned in-between adjacent protrusions 501. System500 further comprises first/inner/device cannula 531 and second/outercannula 532, which may be used to deliver lysing tip 510 therethrough.

System 500 differs from those previously described in that system 500comprises an intermediate hinge member 522 that is pivotably coupled atone end 525 a to a first actuation rod 521 and pivotably coupled at theopposite end 525 b to lysing tip 510. More particularly, intermediatehinge member 522 is pivotably coupled 525 b at the opposite end to base505 via linking member 515. In addition, system 500 comprises a pivotmember 523 that is also coupled to lysing tip 510, but is coupled tolysing tip 510 at a mid-point of lysing tip 510 between its opposingends via linking member 515. Pivot member 523 may also be coupled toactuation rod 520.

FIG. 5 c depicts system 500 in a delivery configuration with lysing tip510 folded up in alignment with the axis of first/inner/device cannula531 and/or second/outer cannula 532. FIG. 5 b depicts anotherperspective view of system 500 in an interim position between thetreatment configuration and the delivery configuration that depicts therear or proximal side of lysing tip 510. As better seen in this figure,the rear of lysing tip 510 comprises a common base 505 from which eachof the protrusions 501 extends. Lysing tip 510 again comprises a base505 coupled to linking member 515. In addition, it can be seen from FIG.5 b that both intermediate hinge member 522 and pivot member 523 arecoupled to lysing tip base 505 via linking member 515.

Some embodiments may be configured such that lysing tip 510 is notaligned with the axis of cannulas 531 or 532 in the deliveryconfiguration. More particularly the axis of lysing tip 510 may bepositioned at an acute angle with respect to the axis of cannulas 531 or532. In other embodiments, lysing tip 510 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 510 fits within the lumen and/or lumens of one and/or bothcannulas.

FIGS. 6 a-6 e depict yet another alternative embodiment of a CDTD system600. FIG. 6 a is a perspective view depicting system 600 in a treatmentconfiguration. System 600 again comprises a plurality of protrusions 601and recessions positioned in between adjacent protrusions 601. In thedepicted embodiment, a lysing member 603 is positioned so as to extendin the recessions and define a plurality of lysing segments 603 a/603b/603 c. Thus, a lysing segment is positioned in each of the recessionspositioned in-between adjacent protrusions 601. System 600 furthercomprises first/inner/device cannula 631 and/or second/outer cannula632, which may be used to deliver lysing tip 610 therethrough.

Although, like system 500, system 600 comprises an intermediate hingemember 622, system 600 differs from system 500 in that system 600comprises an intermediate hinge member 622 that is pivotably coupled atone end 625 a to a first actuation rod 621 but is pivotably coupled atthe opposite end 625 b to a mid-point or near mid-point of lysing tip610 rather than adjacent to an end of lysing tip 610. More particularly,intermediate hinge member 622 is pivotably coupled to a mid-point ornear mid-point of base 605 via linking member 615. Pivot member 623 maybe coupled to actuation rod 620.

System 600 also differs from system 500 in that pivot member 623 iscoupled to an end of lysing tip 610 rather than to a mid-point of lysingtip 610 as in system 500. Because of these pivot/coupling points, lysingtip 610 only extends beyond the cross-sectional profile offirst/inner/device cannula 631 and/or second/outer cannula 632 at oneend (the end opposite from pivot member 623), as shown in FIG. 6 a.

FIG. 6 c depicts system 600 in a delivery configuration with lysing tip610 folded up in alignment with the axis of first/inner/device cannula631. FIG. 6 b better depicts the opposing hinges of intermediate hingemember 622, namely first hinge 625 a and opposite hinge 625 b.

FIGS. 7 a-7 f depict an alternative embodiment of a CDTD system 700.System 700 comprises a lysing tip 710 that is configured to becompletely separated from any other element of the system. In thismanner, lysing tip 710 may be delivered through one cannula 732 and thencoupled with a grasping/control instrument 790 (see FIG. 7 f ) that maybe used to control the lysing tip 710 within the body of a patientduring a surgical procedure. In some embodiments and implementations, asecond cannula, positioned through the same incision or another incisionat another site on the patient's body, such as the cannula 1735 in FIGS.17 f & 17 g, may be used to deliver a transfer grasping instrument, suchas transfer grasping instrument 1796 as depicted in FIGS. 17 f and 17 g, that may be used to facilitate coupling of lysing tip 710 to thegrasping/control instrument 790, which grasping/control instrument 790may be delivered through the same cannula 732 through which the lysingtip 710 is delivered. Alternatively, the lysing tip 710 may be deliveredthough a second cannula along with a transfer grasping instrument usedto couple the lysing tip 710 to grasping/control instrument 790delivered through the first cannula 732, which grasping/controlinstrument 790 may be used to control lysing tip 710 and perform thesurgical procedure. In alternative embodiments, the transfer graspinginstrument may comprise at the distal end other means for grasping thelysing tip 710 such as a hook and/or magnet and/or glue.

Lysing tip 710 may comprise a plurality of protrusions comprising bulbs701. A lysing member 703 may be positioned in recessions 702 fordelivering electrosurgical energy. Each of the segments of lysing member703 may be considered lysing segments 703 a/703 b/703 c. In the depictedembodiment, each of the lysing segments is collectively defined by asingle lysing member 703. However, other embodiments are contemplated inwhich separate lysing members may be used for each of the lysingsegments positioned between adjacent protrusions.

It should be understood that in some embodiments or implementations,such systems 700 can be used in connection without any cannula as shownin FIG. 7 f . Such an embodiment or implementation may be usefulbecause: (A) the surgeon may not be working in a closed cavity thatrequires insufflation (for example, skin, fat, muscle); (B) it may allowthe manufacture of a larger tip configuration than the smallestcannula's constraining dimensions allowing for larger, thicker, strongercomponents than would otherwise be permitted to fit in the smallervolume or pass through a smaller cross-sectional area, or (C) it mayallow smaller diameter entrance incision/wound as cannulas have athickness component.

Each of the protrusions 701 extends from a common base 705 such that theprotrusions 701 are coupled with one another. In some embodiments, eachof the protrusions 701 is integrally coupled with each of the otherprotrusions 701 along base 705. A linking member 715 may be coupled tobase 705 and/or lysing member 703. In this particular embodiment,linking member 715 comprises a grasping pad 718. The structure ofgrasping pad 718 preferably comprises a plate-like shape having opposingsurfaces that match or may be grooved to match the jaws ofgrasping/control instrument 790. In the depicted embodiment, thesurfaces are flat and define parallel planes. Grasping pad 718 may be anintegral part of linking member 715 or be a separate element coupledwith linking member 715. Grasping pad 718 may be used to facilitate adesired coupling between lysing tip 710—which comprises protrusions 701,recessions 702, lysing member(s) 703, and/or linking member 715 and agrasping/control instrument 790 used to control lysing tip 710 during asurgical procedure, which instrument may also be delivered throughcannula 732. Pad 718, in this embodiment, comprises hole 718 c (shown inFIG. 7 e only) which may be used for an alternative means of grasping orotherwise holding the lysing tip 710 in position for grasping/controlinstrument 790 to grasp lysing tip 710. Such additional means mayinclude threading cord and/or suture and/or wire through the hole orotherwise hooking hole 718 c or the like. Additionally, hole 718 h(shown in FIG. 7 d only) may be used to receive a projection 796 a(shown in FIG. 7 f only) mounted on the tip of grasping/controlinstrument to ensure a more stable coupling. In some embodiments, thesurface of tab 718 may be completely electrically insulated except wherecontact is made with upper or lower jaw 793/794. In alternativeembodiments, the entire surfaces of jaws 793/794 and the entire tab maybe insulated except within hole 718 h (shown in FIG. 7 d ) and atprojection 796 a (shown in FIG. 70 which may serve as a conduit forelectrosurgical energy.

Grasping/control instrument 790 may comprise means for grasping and/orcontrolling lysing tip 710. “Controlling” herein may be described asincluding, but not limited to, the physical movement of lysing tip inany direction and/or orientation and the conduction of electrosurgicalenergy to lysing tip. Such grasping/control instrument 790 may comprisegrasping means fixed jaw 794, grasping means moveable upper jaw 793, andshaft 791 that may be comprised of additional means to grasp and/orpermit the flow of electrosurgical energy to the tip 710, such as wires,actuation rods, and the like. In some embodiments, grasping/controlinstrument 790 may further comprise a means for controlling lysing tip710 during a surgical procedure. Grasping/control instrument jaws793/794 may comprise, for example, closable jaws that may be configuredto grasp or otherwise engage linking member 715 via pad 718. An actuator(not shown) may be provided for controlling/actuating such jaws, oranother means for grasping lysing tip 710. Grasping/control instrument790 may be electroconductive in some embodiments such thatelectrosurgical energy may be delivered through jaws 793/794 to lysingtip 710. In some such embodiments, insulation, such as an insulatingcover, may be used to cover conductive areas of grasping/controlinstrument 790. In some embodiments, the insulation (if present) ongrasping/control instrument 790 may extend to at least partially ontojaws 793/794 to avoid delivering electrosurgical energy to undesiredtissues. In other embodiments, electrosurgical energy may be deliveredthrough another element of the system and, thus, grasping/controlinstrument jaws 793/794 may only be used to physically control tip 710and need not be formed from a conductive material (although still may beif desired).

In some embodiments and implementations, grasping/control instrument 790may be replaced with a device such as second transfer/grasping tip, suchas transfer grasping instrument 1796 as depicted in FIGS. 17 f and 17 g, that may be used to facilitate coupling of lysing tip 710. In somesuch embodiments and/or implementations, the lysing tip 710 may bedelivered through a separate cannula, which may comprise variouselements previously mentioned for delivery of the lysing tip 710.Alternatively, the lysing tip 710 may be delivered through the samecannula that is ultimately used to grasp and/or control the lysing tip710 during surgery. In other words, the lysing tip 710 may be pushed outof the distal end of cannula 732, after which grasping/controlinstrument 790 may be used to grasp or otherwise couple to lysing tip710 and used to perform a surgical procedure.

The embodiment in FIG. 7 is similar to the embodiment in FIG. 17 inrespect that the lysing tip may be passed down the inner cannula andgrasped by a second grasping instrument entering the body from anothercannula whereupon the second grasping instrument such as a needle driverand/or hemostat and/or clamp and/or the like may grasp the front of aforward portion of the lysing tip and feed pad 718 back into receivingslot 797 defined by upper and lower jaws 793 and 794.

In FIGS. 8 a-f , a system 800 is depicted which may allow formaintaining control of a free-floating lysing tip and/or facilitatingcoupling of the free-floating lysing tip with a jaw of a graspingcontrol instrument. In system 800, a tether 844 extends through anopening 893 h formed in a jaw 893 of the grasping/control instrument891. Examples of tethers may be cords, bands, wires, sutures or thelike. As used herein, “free-floating” lysing tips are lysing tips thatare releasably coupled with the instrument(s) that are used to energizeand/or control the lysing tips during a surgical procedure. Tether 844may further be configured to be coupled with free-floating, tabbedlysing tip 810. In the depicted embodiment, tether 844 couples withgrasping tab 818. More particularly, grasping tab 818 comprises anopening 818 h configured to receive the tether 844 as shown in thecross-sectional view of FIG. 8 d . In some embodiments, the opening 818h may comprise a blind opening. Alternatively, opening 818 h maycomprise a through-hole. In some embodiments, tether 844 may comprise adistal bulb 844 c and/or stop that prevents tether 844 from pullingthrough the opening 818 h. In the depicted embodiment, bulb 844 c isconfigured to be received in a recess 818 h′ formed in grasping tab 818.Recess 818 h′ may be a portion of opening 818 h having a largerdimension.

In the depicted embodiment, by pulling on tether 844 either manually orby way of a mechanism, tip 810 may be configured to be directed into thejaws 893/894 of grasping/control instrument 891. In still otherembodiments, tether 844 may be coupled with tip 810 without alsoextending through one or both of jaws 893/894. In this manner the tip810 may be retrieved simply by pulling on the tether 844. In otherembodiments, a tether 844 may extend through other portions of thegrasping instrument, such as the bottom jaw 894 and/or both jaws 893/894and/or through the center of the grasping/control instrument 891. Thetether may be packaged with a tether already attached or medicalpersonnel at the procedure may choose an appropriate tether to threadand catch in the lysing tip and thread through the jaw with thethrough-hole.

In some embodiments, one or more cannulas 832 may be used to deliverand/or retrieve lysing tip 810. For example, instrument 891 and lysingtip 810 may be delivered within cannula 832. Alternatively, instrument891 and lysing tip 810 may be delivered without using a cannula in someembodiments and implementations.

In some embodiments such as that depicted in FIG. 8 f , one or moremagnets 892 g on/in one or more jaws 893/894 of grasping controlinstrument 891 may be used to guide lysing tip 810 towards a desiredlocation such as within jaws 893/894. In some embodiments, one or moremagnets 892 t may be positioned along grasping tab 818. In alternativeembodiments, one or more magnets may be positioned along grasping tab818 and/or along one or both of jaws 893/894 (892 t and 892 grespectively).

FIG. 9 depicts a lysing tip comprising non-axial and/or substantiallynon-axial protrusions and a proximal tab. In this embodiment, one ormore protrusions 901 a/901 b/901 c/901 d, recessions 902, and/or lysingmember(s) 903 a/903 b/903 c may not be in an axial configuration. In allother respects, the lysing tip of FIG. 9 may be similar to that tipdepicted in FIGS. 7 a-7 f . In alternative embodiments, the lysing tipsmay be configured to all point in the same non-axial direction. In stillother embodiments, each corresponding protrusion or pair of protrusionsmay be configured to point in the same direction. In still otherembodiments, lysing segments and/or protrusions may be configured topoint perpendicular or substantially perpendicular to the axis.

FIGS. 10 a-10 h depict an embodiment of a CDTD 1000 comprising aplurality of protrusions 1001 comprising the distal tips of beads 1051,comprising individual beads 1051 a/1051 b/1051 c/1051 d, coupled withone another by way of a single lysing member 1060, in the depictedembodiment, a lysing rod 1060, extending through tunnels 1054 extendingthrough each of the respective beads 1051 a/1051 b/1051 c/1051 d. Inthis embodiment, lysing rod 1060 comprises a lysing rod 1060 thatdefines three separate lysing segments 1060 a/1060 b/1060 c formedbetween each bead, and, as described above, may be used to deliverelectrosurgical energy during a surgical procedure. Also, like thepreviously-described embodiments, the areas between each of the adjacentbeads 1051 may define recessions 1002 positioned in between adjacentprotrusions (defined by beads 1051). In the depicted embodiment, each ofthe lysing segments is collectively defined by a single lysing rod 1060.However, other embodiments are contemplated in which separate lysingmembers may be used for each of the lysing segments positioned betweenadjacent protrusions.

Beads 1051, or any of the other beads described herein, are preferablymade from a suitable inert, biocompatible, and non-conductive material,for example, such as a suitable plastic, alumina, zirconia, siliconnitride, silicon carbide, glass, graphite, silicate, diamond,carbon-containing compounds, cermet, or ceramic material or the like, ora combination of one or more of the foregoing.

In the depicted embodiment, lysing rod 1060 is positioned through beads1051 at a location such that beads 1051 may be non-symmetrical and/oreccentric relative to tunnels 1054. In other words, as best shown inFIG. 10 c , tunnels 1054 may be positioned to extend through anon-central location within beads 1051. Moreover, in the depictedembodiment, beads 1051 are non-symmetrical relative to an axis extendingthrough the side-to-side centers of beads 1051 (perpendicular to thelong axis of the beads). In addition, as shown in the figures, thedistal/forward tip of beads 1051 may have a more narrowed end to actmore as a wedge for purposes of acting as a blunt dissector betweentissues and tissue planes; the proximal/non-distal/back portions beingless narrowed and/or larger in volume may create a desirable drag effectthus orienting the bead in a desirable direction for dissection. Whereasthe rear/proximal end of beads 1051 may take many shapes that may belarger and/or more prominent than that of the front/distal end of thebeads. As in FIG. 10 d , the forward tip may be narrowed by use offacets 1052; three are visible and numbered and the fourth is on theopposite side of the one facing the reader. As described later in FIGS.12 aa-rr, a wide variety of alternative bead shapes are possibleincluding, for example, ovoid shapes, spherical shapes, wheel shapes,bullet shapes or other shapes having a flat terminal end (such as, forexample, frusto-shaped), wing shapes, etc. As can be seen from some ofthe examples shown in FIGS. 12 aa-rr, in some embodiments, beads may besymmetrical relative to the openings for receiving the rod. In someembodiments, beads 1051 may be faceted on the top, bottom, sides, frontand/or back such as illustrated in FIGS. 10 c and 10 d , at facet 1052.Facets are preferably formed on the distal/front/leading portions of thebead to facilitate tip movement through/between tissue layers.

In some embodiments, the tunnels 1054 may be positioned in a non-centrallocation within beads 1051. For example, in some preferred embodiments,the tunnels 1054 may be positioned in a forward or distal locationrelative to a central axis of beads 1051. This may be preferable toallow the lysing tip 1010 to be directed through tissue in a desiredmanner, such as without allowing the beads 1051 to rotate on theirrespective tunnels in an undue manner. However, some embodiments may beconfigured to allow a certain amount of such rotation so that the tipcan be maneuvered through patient tissue in a flexible manner.

In some alternative embodiments, the forward or distal portions 1001 ofbeads relative to tunnels 1054 may also, or alternatively, be wider thansuch that beads 1051 have a trailing end that may be longer and/or morenarrow, which may yield desired aerodynamics and/or maneuverability;this may be similar to a ‘kite-tail’ effect.

Preferably, the entire surface of the beads may be smooth, however, somefaceting features may provide for a surface that is less smooth. Forexample, providing a smooth front end and a smooth trailing end mayallow the lysing tip to be moved in a forward direction and then in arearward direction back and forth without catching an undesirable amountof tissue on beads to inhibit such movement. However, as mentionedelsewhere in this disclosure, in some embodiments, the trailing end maycomprise a flat surface such that the entire bead comprises afrusto-ellipsoidal shape or another similar shape. Preferably, at leastthe forward or distal surface of the beads is smooth and defines anellipsoidal shape or another shape having an at least substantiallysmooth forward surface. In alternative embodiments, various portions ofthe bead may be textured or given surface irregularities that may yielda desired dissection orientation such as for example having thenon-proximal/rear portion of the bead roughened on the surface to createdrag from the rear.

In some embodiments, it may be desirable to allow beads 1051 to rotateon lysing rod 1060. Thus, beads 1051 may not be fixedthree-dimensionally with respect to lysing rod 1060 and/or one or moreother elements of lysing tip 1010. In some such embodiments, beads 1051may be at least partially rotatable with respect to the entire lysingtip 1010. For example, the beads may rotate about the rod uponencountering tissue similar to that of a vegetable/fruit peeler. Inembodiments in which beads 1051 are rotatable in this manner, it may bedesirable to use a lysing rod having a circular cross section. Otherembodiments are contemplated in which, instead of being rotatable, thebeads may be otherwise movable with respect to one or more elements of alysing tip 1010. In any such embodiments, such beads may be considerednot three-dimensionally fixed with respect to the lysing rod and/orlysing tip.

In the depicted in FIG. 10 c , protuberances 1065 a/1065 b/1065 c/1065d/1065 e/1065 f formed on the lysing rod 1060 may be created to restrictlateral movement of the beads, and depending upon the distance from abead, may restrict or partially restrict rotational movement of thebeads around the axis of lysing rod 1060. In the preferredimplementation, a LASER or arc welder may be used to heat the conductivematerial comprising lysing rod 1060 causing liquefaction that cools intoa non-uniform structure that increases an outer diameter measurement oflysing rod 1060. Thus, in such embodiments and implementations,protuberances 1065 a/b/c/d may comprise “welds” that deform lysing rod1060. In alternative embodiments, “welds” may comprise added material tolysing rod 1060 through welding techniques in said locations and may belocated at any cross-sectional orientation including facing proximallyor distally. In alternative embodiments, crimps that mechanically deformthe metal at or substantially adjacent to beads may be utilized to holdbeads at particular locations on lysing rod 1060. In additionalembodiments, lysing rod 1060 may be deformed at locations where beads1051 are desired and couple at those locations via a friction fitbetween the bead tunnel and the lysing rod 1060.

Although allowing rotation of beads on a lysing rod may be desired forcertain surgical procedures, it may be desirable to prevent or at leastinhibit such rotation in other embodiments. Thus, in some suchembodiments, tunnels 1054 and/or the lysing rod 1060 may comprise anon-circular shape in cross-section to prevent or at least inhibit suchrotation. In alternative embodiments, beads 1051 may effectively bewelded to the lysing rod 1060 as an alternative method to inhibitrotation. Each bead may comprise hole 1055 that may be positionedperpendicular to lysing rod hole 1054; holes 1055 may be available as aplatform/location to add other features/components such as providing alocation for coupling of a cord as described below in connection withother embodiments and/or locating a sensor and/or RFID locationcomponent and/or being used for placement of luminescent and/or lightproduction element(s) for visualization, for example, tritium and thelike.

In alternative embodiments, hole 1055 d′ may be moved to fully orpartially intersect tunnel 1054 thus allowing communication with lysingrod 1060; thus a weld, plug (for example 1055 p), glue, insert or othermethod of fixation may be inserted via hole 1055 d′ to attach to lysingrod 1060 thus restricting lateral movement of a bead. To reduce escapeof electrosurgical energy through hole 1055 d′, an insulator comprisedof epoxy, plastic, ceramic or the like may be placed in part or all ofthe remaining hole 1055 d′. This alternative embodiment may be appliedto other embodiments herein.

In alternative embodiments, the lysing rod may lack coupling tips at itsoutermost portions. Instead any number of bead holes 1055 d′ may be madeat any number of angles to intersect the lysing rod 1060 and/or itstunnel 1054 to deposit a material that restrains the lysing rod withinthe bead 1051 (for example, materials may include welds, glues, epoxies,plugs, and the like). In such embodiments, tunnel 1054 may be a blindtunnel not requiring full passage through bead 1051 as bead 1051 may befixed/restrained internally (See for example FIGS. 20 j/k showing sideviews of beads 2051 a′ and 2051 a″. FIG. 20 k shows full passage oftunnel 2054 which intersects with hole 2055′ (illustrated with dashedlines designating hole 2055′). FIG. 20 j illustrates tunnel 2054′ whichintersects with hole 2055′ (illustrated with dashed lines designatinghole 2055′) not extending to the outside of outer bead 2051 a″ (2054′illustrated with dashed lines). This feature of this embodiment may beapplied to other embodiments herein. Beads may comprise facets 2052.

The shape of lysing member/lysing rod 1060 may also be important as tothe most efficient and safe means to transfer electrosurgical energyfrom the lysing rod to the tissue(s). Since electrosurgical energyon/under a surface tends to move toward edges of an object, a lysing rodwith a circular cross section may force current to the opposing lysingrod tips and/or protuberances creating hot spots at/near adjacent beadsand/or protuberances. Therefore, it may be beneficial for lysing rod1060 to comprise a non-circular cross section with substantially uniformedges along its length from which electrosurgical energy may uniformlybe transferred to tissues. In contemplated embodiments, a pentagonal orhexagonal cross-sectional shape may be preferable. In other embodiments,spacers with non-circular cross-sections may accumulate less debrisand/or eschar on lysing rod and/or spacer because debris may have a moredifficult time adhering to an angled edge when forces are applied to thedebris.

As shown in FIG. 10 b , actuation rods 1021 and 1022 exit distally frominner/device cannula 1031. The distal terminations of actuation rods1021 and 1022 may contain holes in the distal area through which lysingrod 1060 may extend. Actuation rods 1021/1022 may terminate on theoutermost side of outer beads 1051 a and 1051 d. In alternativeembodiments, actuation rods 1021/1022 may be coupled to the lysing rod1060 between the two outer pairs of beads such as that shown in FIG. 17a.

Lysing rod 1060 may be held in position by features located on the endsof lysing rod 1060, namely coupling tips 1063 and 1064. Coupling tips1063/1064 may have diameters larger than the inner diameter of theircorresponding holes 1026 in actuation rods 1021/1022 respectively. Thecoupling tips may take various shapes. In FIG. 10 c , coupling tip 1063comprises the shape of a mushroom cap and coupling tip 1064 comprisesthe shape of a ball. In alternative embodiments, other shapes may beused to couple the ends of lysing rod 1060 that effectively preventlysing rod 1060 from sliding through either hole 1026. Coupling tips1063/1064 may be made by for example by liquefying the ends by LASERand/or other heating and/or other metal modification methods; and inother embodiments, coupling tips may be separate structural elementssuch as screw-on nuts or the like. In some embodiments, it may bedesirable to provide features and/or elements that inhibit or limit theability of the electrosurgical energy to discharge from the opposingends of the lysing rod. Thus, in some such embodiments, coupling tips1063/1064 may be coated or covered with a suitable insulating materialsuch as an epoxy with non-conductive properties; this may apply to allembodiments herein.

FIGS. 10 f and 10 g demonstrate how the lysing tip 1010 transitionsbetween the delivery and treatment configurations. As shown in FIG. 10 factuation rod 1022 comprises a first bend 1029 a which allows the rearportion of bead 1051 a to be received within a widened defined areadefined by bend 1029 a to allow lysing tip 1010 to pivot from atreatment configuration to a delivery configuration. As can be seen inthis figure, some embodiments may be configured such that lysing tip1010 is not aligned with the axis of cannulas 1031 or 1032 in thedelivery configuration. More particularly the axis of lysing tip 1010 ispositioned at an acute angle with respect to the axis of cannulas 1031or 1032. In some embodiments, a second bend 1029 b may be provided at ornear the distal end of actuation rod 1022 which second bend may be inthe opposite direction of first bend 1029 a, As shown in FIG. 10 g ,hole 1026 is positioned in the middle of second bend 1029 b; second bend1029 b being part of hole 1026 may allow additional rotational movementof lysing rod 1060 as it pivots more toward the delivery configuration.

As shown in FIG. 10 g , opening 1026 may be elongated in the directionof or at least substantially in the direction of the axis of actuationrod 1022 such that as lysing tip 1010 is repositioned between thetreatment and delivery configurations, the portion of lysing rod 1060adjacent to coupling tip 1064 can move/pivot within opening 1026 toallow lysing tip 1010 to similarly pivot with respect to the axis ofcannulas 1031 and/or 1032. The shape of opening 1026 may be oval and/orrectangular or the like. In other words, in the present embodiment,holes 1026 may be elongated shapes, for example, in the form of ovals orrectangles that facilitate the folding away of the lysing tip 1010against the actuation rods 1021 and 1022. In some such embodiments or inalternative embodiments internal beveling around the holes 1026 mayfacilitate movement between treatment and delivery configurations. Insome embodiments and implementations such as depicted in FIG. 10 h ,lysing tip 1010 may be configured such that its beads 1051 are too largeto fit within the lumen of first/inner/device cannula 1031, even in thedelivery configuration. Thus, lysing tip 1010 in its deliveryconfiguration may be positioned just outside (immediately distal) offirst/inner/device cannula 1031 but within second/outer cannula 1032during delivery.

In the present embodiment, coupling tips 1063/1064 are not the sameshape and may be different as pre-formed lysing rods 1060 may bedelivered to the assembly line with mushroom-style coupling tips at oneend, and ball-style coupling tips may be the preferred method to createcoupling tips on a production line to fix the beads 1051 and lysing rod1060 into position relative to actuation rods 1021/1022.

In the present embodiment, actuation rods 1021 and 1022 are notcomprised of any pivotable hinges but are comprised of bends at variouslocations along actuating rods to facilitate deployment and control oflysing tip 1010. In alternative embodiments, hinges and/or control cordsmay be placed along the length of actuation rods to facilitate movementin other directions.

FIG. 10 h depicts an alternative configuration similar to that of FIG.10 f . However, in the configuration of FIG. 10 h , the lysing tip 1010is configured such that it cannot be fully received within cannula 1031.In some embodiments and implementations, cannula 1031 may comprise aninner cannula in which case an outer cannula (not shown in FIG. 10 h )may also be used. Preferably, in such configurations the lysing tip 1010may be fully received within the outer cannula in its deliveryconfiguration.

FIG. 10 e is a top view illustrating system 1000 that lysing rod 1060may deform when tip 1010 encounters resistance during a surgicalprocedure. In the figure, the center beads 1051 b/1051 c are pushedproximally deforming lysing rod 1060.

System 1000 comprises means for fixing or guiding the ‘rotationalorientation’ of lysing tip 1010 with respect to first/inner/devicecannula 1031. In some embodiments the rotational fixing means may alsoprovide proximal support to lysing tip 1010 during a surgical procedure.Rotational fixing means 1033 is configured to engage actuation rods1021/1022. More particularly, in the depicted embodiment, rotationalfixing means 1033 comprises opposing slots 1033 a and 1033 b formed inthe distal end of first/inner/device cannula 1031, which slots aresized, shaped, and configured to receive at least a portion of actuationrods 1021/1022 when deployed distally. Other examples of rotationalfixing means 1033 include hooks, catches, etc. In addition, in anotherexample of a rotational fixing means, corresponding features on thedeployment side of lysing tip 1010 may engage the distal end or specialfeatures designed in the distal end of first/inner/device cannula 1031,in some embodiments 1033 a and/or 1033 b, and such seating may providedirect support restricting proximal movement and/or fixing the tipagainst rotation.

Each bead may have a height BH as illustrated in FIG. 10 d and a lengthBL extending perpendicular to the axis of the lysing rod 1060. Each beadalso has a width BW as shown in FIG. 10 e . Similarly, lysing tip 1010may have a length TL which preferably extends in the same direction asthe axis of lysing rod 1060 and a tip width TW extending perpendicularto the tip length TL as shown in FIG. 10 e and a tip height TH as shownin FIG. 10 d . In some embodiments, the tip height TH may be identicalto the bead height BH. However, in other embodiments, the tip height maydiffer from the bead height.

FIGS. 11 a-11 e depict various views similar to those depicted in FIGS.10 a-10 h for an alternative embodiment of a CDTD system 1100. System1100 differs from system 1000 in that spacers 1162 a/1162 b/1162 c maybe positioned between bead pairs 1151 a/1151 b, 1151 b/1151 c, and 1151c/1151 d. System 1100 is comprised of first/inner/device cannula 1131and second/outer cannula 1132 through which lysing tip 1110 may bedeployed or retrieved via actuation rods 1121 and 1122. In the depictedembodiment, each of the respective lysing segments between each beadpair comprises a spacer 1162 (1162 a/1162 b/1162 c) that may beconfigured to space the various beads 1151 apart, provide stability tothe lysing tip, and/or protect the respective lysing segments (which, inthe depicted embodiment, are collectively defined by a single lysingmember/lysing rod 1160). Preferably, spacers 1162 comprise a conductivematerial, such as a suitable biocompatible metal, that can receiveelectrosurgical energy from the lysing member 1160 and deliver it tovarious body tissues during a surgical procedure. Preferably, spacer(s)1162 are therefore in direct contact with lysing member 1160. In someembodiments, a single spacer 1162 may both extend between the variousbeads 1151 and extend through the tunnels 1154 through the beads 1151.Lysing rod 1160 terminates on its opposing ends at coupling tips 1163and 1164 that may hold the bead/lysing rod/spacer components in positionbetween actuation rods 1121 and 1122. Each bead may comprise hole 1155that may be positioned perpendicular to lysing rod hole 1154; holes 1155may be available as a platform/location to add otherfeatures/embodiments and/or to be used for cord/suture attachments forlysing tip manipulation and/or removal and/or be used for placement ofluminescent and/or light production for visualization, for example,tritium and the like. Each bead 1151 may comprise one or more facets1152.

Spacers 1162 a/1162 b/1162 c may be coupled with lysing rod 1160 by, forexample, sliding spacers 1162 comprising a lumen along the axis oflysing rod 1160. Alternatively, spacers 1162 may be coupled with lysingrod 1160 by placing spacers 1162 over lysing rod 1160 in a directionperpendicular to the axis of the lysing rod at a desired location usinga slot or other opening formed along a portion of a perimeter spacer1162. For example, spacers may be provided with a slit extending alongtheir respective axes. Such spacers may then be coupled with a lysingrod by aligning the slit with the lysing rod and pressing the spacertowards the lysing rod to snap it in place. In some embodiments andimplementations, spacers 1162 may be crimped or otherwise fixedlycoupled with lysing rod 1160 at a desired location. In some embodiments,this fixed coupling may be configured to prevent the relative movementbetween lysing rod 1160 and spacer 1162 possibly reducing hot spotscaused from high current density flow in certain areas between lysingrod 1160 and spacer 1162. These exemplary methods for applying spacersto a lysing rod and/or another lysing member may be apply to any of theother embodiments utilizing spacers.

In some contemplated embodiments spacers may be comprised of insulatingmaterials (such as ceramic, glass, plastic and the like) that may haveholes (illustrated in FIG. 12 j ) and/or be porous and/or have breaksand/or have separations such that energy from lysing member(s) withinmay be released into target tissues.

In some such embodiments, beads 1151 may be at least partially rotatablewith respect to the entire lysing tip 1110. In embodiments in whichbeads 1151 are rotatable in this manner, it may be desirable to use alysing rod having a circular cross section. It may also be desirable toeither omit spacers 1162 or form them without the beveled edges as shownin 12 i and 12 j.

Spacers 1162 may be used to prevent rotation of beads 1151 or toselectively limit the amount of rotation of beads 1151 on a lysingmember 1160. For example, if spacers 1162 extend the entire distance orat least substantially the entire distance between each adjacent bead,spacers may prevent rotation or, depending upon the distance betweenspacers and adjacent beads, may be used to allow for a predeterminedamount of such rotation. Similarly, the opposing ends of spacers 1162may be shaped to match or at least substantially match the shape of theadjacent bead(s) again to either prevent or control rotation.

The shape of lysing member/lysing rod 1160 and/or spacers 1162 may alsobe important so as to provide selective energy-to-tissue delivery.Electrosurgical energy on/under a surface may tend to move toward edgesof an object. In some embodiments, therefore, it may be beneficial forlysing rod 1160 and/or spacer 1162 to comprise a non-circular crosssection with acute or substantially acute cross-sectional angles alongits perimeter thus creating a lysing rod with edges that may increaseelectrosurgical energy discharge in those areas. In contemplatedembodiments, a pentagonal or hexagonal cross-sectional shape may bepreferable. Additionally, spacers with non-circular cross-sections mayaccumulate less debris and/or eschar on lysing rod and/or spacer becausedebris may have a more difficult time adhering to an angled edge.

System 1100 is otherwise similar to system 1000. For example, system1100 comprises areas between each of the adjacent beads 1151 that definerecessions 1102 positioned in between adjacent protrusions 1101 (definedby distal/leading portions of beads 1151). In addition, lysing rod 1160defines lysing segments that are positioned between each of the adjacentbeads 1151.

In some embodiments, the tunnels 1154 may be shaped and/or sized suchthat the lysing rod 1160 alone can provide the needed rigidity andstructure to separate beads 1151 without providing spacers.

In some embodiments and implementations such as depicted in FIG. 11 f ,lysing tip 1110 may be configured such that its beads 1151 are too largeto fit within the lumen of first/inner/device cannula 1131, even in thedelivery configuration. Thus, lysing tip 1110 in its deliveryconfiguration may be positioned just outside (immediately distal) offirst/inner/device cannula 1131 but within second/outer cannula 1132during delivery.

FIGS. 12 a -12 rr depict 3 general components of the lysing tip andvarious potential shapes: Lysing rod (FIGS. 12 a-12 g ), spacers (FIGS.12 h-12 t ), and beads (FIGS. 12 aa-12 rr).

FIGS. 12 a-12 g depict various examples of cross-sectional shapes ofwires or other lysing members. In some embodiments, these shapes may beformed by crimping a wire or other suitable lysing member into thedesired shape. Crimping the lysing member may be particularly useful inconnection with certain embodiments and/or implementations of theinvention, as it may facilitate a preferred coupling between variousother elements of the CDTD system, such as the beads and/or spacers.Crimping may also, or alternatively, be useful in providing for apreferred delivery of electrosurgical energy through the wire/lysingmember. Other methods of shaping the lysing member may include but notbe limited to cutting, polishing, forging or forming by extrusion. Inadditional embodiments, various coatings may be applied to lysing rodsthat may reduce adhesion of heated biological material to the lysing rodor spacers.

FIG. 12 a comprises a lysing rod having a circular cross-section. Theshape of lysing member/lysing rods may also be important as to the mostefficient and safe means to transfer electrosurgical energy from thelysing members to the tissue(s). Electrosurgical energy on/under asurface may tend to move toward edges of an object. This shape may beuseful for allowing a useful distribution of a coating to the surface ofthe lysing rod that may be used to reduce char buildup and/or modifyease of movement of a lysing tip through tissue. FIG. 12 b comprises alysing rod having a triangular cross-section; this may be useful formaximizing electrosurgical energy discharge and minimizing char build-upabout the lysing rod. FIG. 12 c comprises a lysing rod having a squarecross-section. FIG. 12 d comprises a lysing rod having a pentagonalcross-section along its length while FIG. 12 dx comprises a lysing rodhaving a pentagonal cross-section that is twisted along its length. FIG.12 e comprises a lysing rod having a hexagonal cross-section. FIG. 12 fcomprises a lysing rod having a wedge-shaped cross-section. FIG. 12 gcomprises a lysing rod having a semi-circular or frusto-circularcross-section.

FIGS. 12 h-12 t depict various shapes for spacers that may be used inconnection with one or more of the embodiments disclosed herein. Eachmay have a hole through which lysing members may extend. As illustratedin these figures, FIG. 12 h illustrates a spacer having flat ends and acylindrical shape. FIG. 12 i illustrates a spacer having a circularcross-section and tapered ends which may be useful for allowing adesired distribution of a coating to the surface of the spacer to reducechar buildup and/or modify ease of movement of a lysing tip throughtissue. FIG. 12 j comprises various openings, such as holes, fordelivery of electrosurgical energy therethrough; this may allow formaking spacers of a non-conductive material and still deliver suchenergy therethrough. FIG. 12 k illustrates an alternative spacer that isarced. FIGS. 12L (resting) and 12 m (stressed) illustrate an alternativespacer having opposing loops with central openings configured to allowfor receipt of a wire or other lysing rod therethrough and a flexibleconnector extending between the two loops. As shown in FIG. 12 m , oncecoupled with adjacent beads (not shown), the flexible connector may bendto serve as a brace and space apart the adjacent beads. This spacer mayalso be configured such that the opposing loops may be flexed to theside to allow for coupling of adjacent beads and receipt of a lysing rodtherethrough (not shown). FIG. 12 n illustrates a cross-sectional viewof another spacer having a triangular cross-sectional shape and anopening for receipt of a lysing rod therethrough. FIG. 12 o illustratesa cross-sectional view of another spacer having a rectangularcross-sectional shape and an opening for receipt of a lysing rodtherethrough. FIG. 12 p illustrates a cross-sectional view of anotherspacer having a pentagonal cross-sectional shape along its length and anopening for receipt of a lysing rod therethrough while FIG. 12 pxcomprises a spacer having a pentagonal cross-section that is twistedalong its length and an opening for receipt of a lysing rodtherethrough. Spacers with twisted features may acquire less debrisalong its surface and may tend to rotate thus multiple sides of a spacerare exposed to charred tissue. FIG. 12 q illustrates a cross-sectionalview of another spacer having a hexagonal cross-sectional shape and anopening for receipt of a lysing rod therethrough. FIG. 12 r illustratesa blade-style cross-sectional shape with smooth, rounded outer surfacesthat meet at the distal edge and an opening for receipt of a lysing wireor other lysing rod therethrough. FIG. 12 s illustrates across-sectional view of another spacer having a blade cross-sectionalshape (differing from FIG. 12 r in that outer surfaces are formed byintersecting planar/flat surfaces) and an opening for receipt of alysing wire or other lysing rod therethrough. FIG. 12 t illustrates across-sectional view of another spacer having a spindle cross-sectionalshape and an opening for receipt of a lysing wire or other lysing rodtherethrough.

The cross-sectional shape of the exterior surface of spacers 12-4 mayalso be important as to the most efficient and safe means to transferelectrosurgical energy from spacers to the tissue(s). Electrosurgicalenergy on/under a surface may tend to move toward edges of an object, soa spacer with an exterior surface having a circular cross section mayforce current to the opposing spacer ends creating hot spots at/nearadjacent beads. Therefore, it may be beneficial for spacers to comprisean exterior surface having a non-circular cross section with one or moresubstantially uniform edges along its length from which electrosurgicalenergy may uniformly be transferred to tissues. In contemplatedembodiments, a pentagonal or hexagonal cross-sectional shape may bepreferable. Additionally, spacers with non-circular cross-sections mayaccumulate less debris and/or eschar on lysing rod and/or spacer becausedebris may have a more difficult time adhering to an angled edge. Insome embodiments, one or more (in some embodiments, all) of the spacersmay comprise a leading edge for delivery of electrosurgical energy fromthe lysing member(s). In some such embodiments, one or more of thespacers may comprise only a single such leading edge. In some suchembodiments, the spacer(s) may comprise a smooth, or at leastsubstantially smooth, exterior surface, other than the single leadingedge. For example, the spacer(s) (or, in some embodiments, the lysingmember/rod itself) may comprise a circular or oval shape in crosssection with a flattened leading end terminating in a leading edge. Thismay be useful for controlling the delivery of electrosurgical energy.

Because the spacers may be configured to receive the lysing member/rodtherethrough, the spacers may also comprise an opening extendingtherethrough for receiving the lysing member/rod. Thus, the spacers mayalso have an interior cross-sectional shape, which may differ from theshape of the exterior surface. For example, it may be useful to form thespacers with an opening having a cross-sectional shape that matches thecross-sectional shape of the lysing member/rod. Thus, if the lysingmember/rod comprises a circular or polygonal shape in cross-section, thespacer(s) may comprise an opening having a similar cross-sectionalshape. In some embodiments, the shape of the exterior surface of thespacers may therefore be used to primarily dictate preferred deliverylocations for the electrosurgical energy.

FIGS. 12 aa-12 rr show 12-5 alternative shapes for beads positionedalong a lysing tip. As illustrated in these figures, bead shapes thatmay be useful may include spheres (FIG. 12 aa), wheel shapes (FIG. 12bb), dodecahedron shapes (FIG. 12 cc). In other embodiments, bead shapesmay be bullet-shaped or partially or substantially ellipsoidal (FIGS. 12dd-12 ff) and may have facets (FIGS. 12 ee and 12 ff). In othercontemplated embodiments, beads of various geometries may be cut offhaving flat or slightly curved proximal surfaces or further shaped bygeometric cuts (FIGS. 12 gg-12LL) (herein, this may be referred to as“frusto-shaped”). In other contemplated embodiments, bead shapes and/ortunnels through them may be uniform spherical and/or centered. In othercontemplated embodiments, beads may have skeleton features supported bya hub that may be adjacent to the lysing rod or adjacent to or formedaround a ceramic sleeve through which a lysing rod is extended (FIGS. 12mm-12 rr). 12-6 In some contemplated embodiments, providing a roughtrailing end may create frictional drag on that portion of the bead thushelping reorient the front end of the bead for further tissue passage.Thus, in some embodiments, the trailing end may have a rougher surfacethan the front end. For example, in some embodiments, the trailing end,or at least a portion of the trailing end, of one or more beads may besanded with a rougher sanding material than the leading end, may beformed with ridges, grooves, or other roughening elements, or mayotherwise be made with a less smooth surface for this purpose. In somecontemplated embodiments such as that depicted in FIG. 12 rr, a bead maycomprise a slot beginning at its trailing end and terminating within thebead 12 rr so as to allow for receipt of a lysing rod therein. In somesuch embodiments, a hole 1255 may be positioned to extend through thebead and may at least partially intersect with slot 1253. Thus a weld,plug, glue, insert or other method of fixation may be inserted via hole1255 to attach to a lysing rod thus restricting movement of a beadand/or rotation of the bead with respect to its lysing rod.

In alternative embodiments, beads may comprise a conductive materialsuch as metal and coated with an insulator; for example, a bead shapedsuch as FIG. 12 rr but made of metal (internally) may be pressed over alysing rod with increased pressure closing the slot behind the lysingrod causing the bead to remain in place along a lysing rod.

FIGS. 13 a-13 i depict another embodiment of a CDTD system 1300comprising a plurality of beads 1351 positioned on lysing member 1360which comprises lysing plate 1360. It should be noted that in theembodiments of 13 a-13 i, beads 1351 are supported laterally by lysingplate 1360. It should also be noted that beads 1351 lack a base, such asbase 105 for system 100, and instead define a lysing tip that lacksstructure immediately behind the beads for support. It should also benoted that lysing tip 1310 comprises beads 1351 (1351 a/1351 b/1351c/1351 d) that project both distally and proximally relative to lysingplate 1360.

System 1300 may be configured to allow for repositioning of lysing tip1310 between a delivery configuration and a treatment configuration. Inthe delivery configuration, the axis of each of the elongated beads 1351towards the treatment side may be configured to extend in a directionthat is at least substantially perpendicular to the cannula axis andlysing tip 1310 (the axis between the two outer beads 1351 a/1351 d) maybe configured to extend in a direction that is at least substantiallyparallel to the cannula axis. In addition, in the depicted embodiment,lysing tip 1310 may be configured such that an energy delivery side oflysing tip 1310 in front of protrusions 1301 defined by theleading/proximal tips of beads 1351 and the relative recessions 1302,which energy delivery side will ultimately deliver electrosurgicalenergy for dissecting tissue, faces an interior surface of a lumen ofcannula 1331 through which lysing tip 1310 is delivered. Followingdelivery of lysing tip 1310 through a distal end of cannula 1331, system1300 may be configured to reposition lysing tip 1310 to the treatmentconfiguration in which the energy delivery side extends at leastsubstantially perpendicular to the cannula axis.

As shown in FIG. 13 d , system 1300 comprises two separate cannulas,namely, a first or first/inner/device cannula 1331 which preferablycomprises a lumen of sufficient diameter to allow folded lysing tip 1310(in a delivery configuration) to be positioned within the lumen offirst/inner/device cannula 1331, and a second cannula 1332, which mayhave a larger cross-sectional diameter. In some embodiments andimplementations, lysing tip 1310 may be configured such that its beads1351 are too large to fit within the lumen of first/inner/device cannula1331, even in the delivery configuration. Thus, lysing tip 1310 in itsdelivery configuration may be positioned just outside (immediatelydistal) of first/inner/device cannula 1331 but within second/outercannula 1332 during delivery. By providing two co-axial cannulas,actuation rods 1321 and 1322 and/or actuation rod pairs 1321/1323 and1322/1324 may be prevented, or at least substantially prevented, frombeing separated from one another or otherwise system 1300 may beconfigured to maintain better control over lysing tip 1310 duringdeployment. Thus, preferably, actuation rods 1321/1322 and/or actuationrod pairs 1321/1323 and 1322/1324 are also delivered throughfirst/inner/device cannula 1331. Retraction 1325 is preferably near tip1310 at or near the distal end of one of actuation rods 1321/1322.

In this embodiment, distal actuation rods 1321 and 1322 are formed withtwo bends that bring the distal end of the actuation rods perpendicularwith the main axis of the actuation rods but parallel to the elongatedaxis of the lysing plate 1360 in the treatment configuration. Thisconfiguration may be advantageous during the delivery configuration tooptimize the volume needs within cannulas. In the present embodiment,actuation rods 1321 and 1322 may have cutouts in the distal tipsallowing for lysing plate 1360 to be received in the distal tips ofactuation rods 1321/1322. Alternatively, the lysing plate 1360 maycomprise recesses that permit the actuation rods 1321/1322 to seatwithin the lysing plate 1360.

Lysing tip 1310 may comprise an orientational-deployment side oppositefrom the energy delivery side. The orientational-deployment side oflysing tip 1310 may be configured to allow lysing tip 1310 to berepositioned between the delivery configuration and the treatmentconfiguration described above. A deployment assembly may be coupled withthe orientational-deployment side of lysing tip 1310. This deploymentassembly may be configured to allow for selective repositioning betweenthe delivery and treatment configurations. In the depicted embodiment,the deployment assembly may comprise one or more pivot members, such aspivot members 1316 and 1317. Pivot members 1316 and/or 1317 may comprisevarious elements configured to allow for selective pivoting, rotation,and/or angulation of lysing tip 1310, such as joints, ball pivots,hinges, pins, groove/slot pairs, etc., such that lysing tip 1310 can bepivoted, rotated, or “folded” between its deployment and treatmentconfigurations.

Pivot members 1316 and 1317, such as pins or the like, may be coupled atone end to the lysing plate 1360 at holes 1368 a and 1368 b and may befurther coupled with actuation rods 1322 and 1321, respectively. In someembodiments, pivot members 1316/1317 may therefore be configured to bereceived in holes formed in both lysing plate 1360 and correspondingaligned holes formed within actuations rods 1321/1322. Thus, uponadvancing one or both of actuation rods 1322 and 1323, lysing tip 1310may be advanced in its delivery configuration down first/inner/devicecannula 1331. In some embodiments, appropriate wires or othertransmission lines for delivery of electrosurgical energy may bepositioned to extend through one or more of the various actuation rods.Alternatively, in some embodiments, electrosurgical energy may bedelivered directly through one or more actuation rods. In someembodiments, wires or other transmission lines for delivery ofelectrosurgical energy may instead, or additionally, extend though otherregions of lumen, as previously described. Actuation rods 1321 and/or1322 and/or actuation rod pairs 1321/1323 or 1322/1324 may comprise anysuitable material depending on whether electrosurgical energy is beingdelivered through them. For example, a metal or other conductivematerial may be used if electrosurgical energy is to be deliveredthrough the actuation rods, or a plastic or other insulating materialmay be used if electrosurgical energy is to be delivered throughseparate wiring or other suitable transmission lines.

Some embodiments may further comprise one or more additional jointsand/or pivot members positioned proximally relative to pivot members1316 and 1317. For example, some such embodiments may comprise hingesand/or pivot members 1327/1328 that are positioned within one or both ofactuation rod pairs 1321/1323 or 1322/1324, as previously described inFIGS. 1 a-j . Such hinges may allow for one or both of distal actuationrods 1321/1322 to be pivoted/rotated in a desired direction once lysingtip 1310 has exited the terminal end of cannula 1331 and/or 1332.

System 1300 differs from Systems 800 and 900 in that lysing member 1360comprises a plate 1360. Plate 1360 may extend through horizontal tunnels1352 within the various beads 1351. Beads 1351 may also have verticaltunnels 1355. Thus, beads 1351 may be more permanently coupled withplate 1360 by way of holes within plate 1360, such as 1369 a/1369 b/1369c/1369 d formed within plate 1360 configured to correspond to holes 1355located in beads 1351. In some embodiments, pins, screws, rivets or thelike or epoxy, or metallic welds may extend through vertical tunnels1355 and holes 1369 a/1369 b/1369 c/1369 d to affix the two elementstogether. In alternative embodiments, holes 1369 a/1369 b/1369 c/1369 dmay be replaced by bevels. Thus, in some embodiments, horizontal and/orvertical tunnels may not be needed. However, in other embodiments, plate1360 may comprise beveled or narrowed regions configured to fit withinsuch tunnels formed within beads 1351. Because use of a plate 1360 mayprovide more rigidity than certain other embodiments, use of spacers maynot be needed for lysing tip 1300.

System 1300 comprises areas between each of the adjacent protrusions1301 (defined by the distal/front ends of adjacent beads 1351 a-d) thatdefine recessions 1302. Plate 1360 may define lysing segments 1360a/1360 b/1360 c that are positioned between each of the adjacent beads1351 a-d. Each of these lysing segments may be collectively defined by asingle lysing member/plate 1360 or, in other embodiments, separatelysing members/plates may be used for each of the lysing segmentspositioned between adjacent protrusions/beads.

As shown in FIG. 13 d , the hinge structure may allow for rotation oflysing tip 1310 above and/or below the cross-sectional profile ofcannula 1331 and/or 1332 and may allow lysing tip 1310 to extend beyondthe cross-sectional profile of cannula 1331 and/or 1332 along one orboth of the opposing ends of the lysing tip 1310.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 1331 may vary as forexample, as shown in FIGS. 16 k and 16L. In other words, the lysing tip1310 in the axial deployment configuration may be unable to be receivedwithin cannula 1331 such as shown in FIG. 16L or may be unable to bereceived within an inner cannula of two delivery cannulas as shown inFIG. 16 k . In embodiments comprising two cannulas, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only need to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Such embodiments may be useful for cosmeticprocedures within the skin, for example, but not limited to, for facelifting and/or cellulite treatment.

Another embodiment is depicted in FIGS. 14 a-14 n . System 1400comprises lysing tip 1410 comprising recessions 1402 created by adjacentprotrusions 1401. Lysing tip 1410 further comprises a support member1470 defining a bow shape through which holes 1472 and 1473 extendvertically. In the depicted embodiment, hole 1472 is offset from hole1473 on support member 1470, such as with respect to the lysing rod1460, for example. This may facilitate a preferred pivoting of lysingtip 1410 between treatment and delivery configurations. Holes 1472/1473may configured to receive pins for coupling lysing tip 1410 to actuationrods 1422 and 1421 respectively. Support member 1470 and/or holes1472/1473, in some embodiments, may not be symmetrical with respect toone or more points and/or axes, such as one or more central axes oflysing tip 1410, such as the axis defined by lysing rod 1460 and/or thecenter axis of the lysing tip 1410 from a plan view extending betweenthe treatment and deployment/orientation sides of the lysing tip 1410,in order to facilitate movement between the treatment and deliveryconfigurations. For example, in the depicted embodiment, if an XY gridis imposed over FIG. 14 g with the Y-axis bifurcating lysing rod 1460and the X-axis touches the lower most feature of support member 1470,then holes 1472 and 1473 may not have the same y-coordinate. In otherwords, holes 1472 and 1473 may be positioned at different distances fromlysing rod 1460 or are non-symmetrical with respect to lysing rod 1460.Furthermore, in some embodiments, holes 1472/1473 may be positioned atdifferent distances from the center of support member 1470.

Support member 1470 may be preferably insulated, except within one orboth sets of its two sets of holes, to prevent unwanted delivery ofelectrosurgical energy to tissues; thus, electrosurgical energy isdirected to support member holes at which lysing rod 1460 becomesenergized for energy delivery.

In the depicted embodiment, knobs 1475 a and 1475 b are provided onsupport member 1470 in order to provide additional material support suchthat holes 1472 and 1473 can be formed in a desired location. In thisembodiment, holes 1472 and 1473 may be positioned within and/or adjacentto knobs 1475 a and 1475 b respectively.

Lysing tip receptacle 1421 a on distal actuation rod 1421 comprises acutout formed in the distal control arm into which the bottom of supportmember 1470 recesses. In other embodiments, the lysing tip receptaclemay instead comprise a recess that is not fully cut out.

Actuation rod 1422 further comprises opening 1422 a such that whenlysing tip 1410 is in the delivery configuration, fastening member ofhinge 1427 enters opening 1422 a to facilitate maximum proximal movementof the actuation rods relative to each other.

As shown in FIG. 14 c , system 1400 comprises two separate cannulas,namely, an outer cannula 1432 which preferably comprises a lumen ofsufficient diameter to allow folded lysing tip 1410 (in a deliveryconfiguration) to be positioned within the lumen of cannula 1432, and afirst inner/device cannula 1431 which comprises a lumen of sufficientdiameter to allow folded lysing tip 1410 (in a delivery configuration)to be positioned within the lumen of cannula 1431. In certainembodiments, such as in FIGS. 14 i and 14 j , lysing tip 1410 in thedelivery configuration may have one or more cross-sectional dimensionsthat may exceed the inner diameter of inner/device cannula 1431 and thusmay not retract partially or fully into inner/device cannula 1431.However, in some such embodiments, lysing tip 1410 may still retractfully into outer cannula 1432 during deployment or retraction. Moreparticularly, lysing tip 1410 may be configured such that its beads 1451a/b/c/d are too large to fit within the lumen of inner/device cannula1431, even in the delivery configuration. Thus, lysing tip 1410 in itsdelivery configuration may be positioned just outside (immediatelydistal) of inner/device cannula 1431 but within outer cannula 1432during delivery.

Any of the embodiments described herein may be configured such that thetip 1410 cannot be fully received within second cannula 1432 as shown inFIG. 14 c . Or alternatively, any of the embodiments disclosed hereinsuch that the entire tip may be fully received within first/inner/devicecannula 1431. This embodiment may be useful because it permits the tipto be as large as possible given the dimension constraints of the outercannula and not the inner cannula thus reducing the expense of furtherminiaturizing.

Some embodiments may be configured such that lysing tip 1410 is notaligned with the axis of cannulas 1431 or 1432 in the deliveryconfiguration. More particularly the axis of lysing tip 1410 may bepositioned at an acute angle with respect to the axis of cannulas 1431or 1432. In other embodiments, lysing tip 1410 may be configured toextend at an acute angle relative to the cannula axis so long as theaxis of lysing tip 1410 fits within the lumen and/or lumens of oneand/or both cannulas such as illustrated in FIG. 10 f or 11 f

By providing two co-axial cannulas, actuation rods 1421 and 1422 may beprevented, or at least substantially prevented, from being separatedfrom one another or otherwise system 1400 may be configured to maintainbetter control over lysing tip 1410 during deployment. Thus, preferably,actuation rods 1421 and 1422 are delivered through both cannulas 1431and 1432.

Lysing rod 1460 extends through all beads and terminates in outer beads1451 a/1451 d coupling all beads with lysing rod 1460 and structuralmember 1470 via coupling tips 1463 terminating within outer beads 1451a/1451 d. In this embodiment, the configuration of the tunnels in themiddle and end beads may capture corresponding elements as described inprevious embodiments. In some embodiments, it may be desirable toprovide features and/or elements that inhibit or limit the ability ofthe electrosurgical energy to discharge from the opposing ends of thelysing rod 1460 at coupling tips 1463/1464. Thus, in some suchembodiments, coupling tips 1463/1464 may be coated or covered with asuitable insulating material such as an epoxy with non-conductiveproperties. Alternatively, outer bead hole 1454 at the end with thelarger-opening may be capped or plugged with an element configured to bereceived or otherwise engage the larger opening of the bead. Preferably,this element will have non-conductive properties similar to theinsulating material previously referenced.

In this embodiment, spacers 1462 a/1462 b/1462 c may be positionedbetween bead pairs 1451 a/1451 b, 1451 b/1451 c, and 1451 c/1451 d. Inthe depicted embodiment, each of the respective lysing segments betweeneach bead pair comprises a spacer 1462 (1462 a/1462 b/1462 c) that maybe configured to space the various beads 1451 a/b/c/d apart, providestability to the lysing tip, and/or protect the respective lysingsegments (which, in the depicted embodiment, are collectively defined bya single lysing member/lysing rod 1460). Preferably, spacers 1462comprise a conductive material, such as a suitable biocompatible metal,that can receive electrosurgical energy from the lysing member 1460 anddeliver it to various internal body tissues during a surgical procedure.Preferably, spacer(s) 1462 are therefore in direct contact with lysingmember 1460. In some embodiments, a single spacer 1462 may both extendbetween the various beads 1451 a/b/c/d and extend through the tunnels1454 through the beads 1451 a/b/c/d. In some contemplated embodiments,spacers may be comprised of insulating materials (such as ceramic,glass, plastic and the like) that may have holes and/or be porous and/orhave breaks and/or have separations such that energy from lysingmember(s) within may be released into target tissues to have effect suchas that illustrated in FIG. 12 j . As discussed earlier, in someembodiments, spacers may have a circular cross-sectional profile whichmay facilitate adhesion of surface coatings which may have functions,including but not limited to, such as reduction in char buildup and/orease of movement of lysing tip through tissue. However, in someembodiments electrical discharge may be enhanced across the length ofthe lysing member 1460 via a cross sectional profile with acute orsubstantially acute angles, for example, pentagonal or hexagonal shapes.Additionally, spacers with non-circular cross-sections may accumulateless debris and/or eschar on lysing rod and/or spacer because debris mayhave a more difficult time adhering to an angled edge.

Beads 1451 a-d may be positioned along lysing rod 1460 differently inalternative embodiments. For example, in FIG. 14 h , in someembodiments, spacers 1462 a-c may be removed and protuberances 1465c/1465 d such as welds may be placed on each side of the middle beads1451 b/c and may face proximally, distally or therebetween. Inalternative embodiments, spacers 1462 a-c may be removed and lysing rod1460 may be deformed on each side of the middle beads 1451 b/c such thatthe beads may not slide past the deformation. With respect to suchembodiments, these deformations may also be considered protuberances asthis term is used herein. In alternative embodiments, spacers 1462 a-cmay be removed and lysing rod 1460 may be deformed, such as flattening,making ellipsoidal in cross section, or otherwise modified, prior tocoupling with the middle bead(s) such that the outer diameter of lysingrod 1460 may couple via friction fit with the inner tunnel surface ofmiddle beads 1451 b/c. In alternative embodiments, spacers 1462 a-c maybe deformed on lysing rod 1460 to a degree that spacers may no longerrotate around lysing rod 1460 and the new cross-sectional shape ofspacers 1462 a-c may have a beneficial effect.

In the current embodiment, outer beads 1451 a and 1451 d are theapproximate same length as middle beads 1451 b and 1451 c; this shorterouter bead configuration may allow for more complete folding of thelysing tip during the delivery configuration.

Retraction guide 1425 is preferably near tip 1410 at or near the distalend of one of actuation rods 1421/1422. In the depicted embodiment,retraction guide 1425 is positioned near the distal end of actuation rod1422 adjacent to (immediately proximal of) tip 1410. In someembodiments, retraction guide 1425 may comprise a resilient material,such as a spring, so that it provides a restorative force duringretraction of tip 1410 into cannula 1431. Preferably, retraction guide1425 is positioned and configured so as to extend from actuation rod1422 laterally by a distance at least approximately equal to, in someembodiments slightly greater than, the distance one or more of theprotrusions 1401 that extend laterally relative to actuation rod 1422 inthe retracted/folded configuration. In some embodiments, retractionguide 1425 may extend in this direction a distance equal to, or slightlygreater than, the largest protrusion 1401 (in embodiments in which eachof the protrusions are not identical and/or do not project an equaldistance).

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 1431 may vary as forexample, as shown in FIGS. 14 k and 14L. In other words, the lysing tip1410 in the axial deployment configuration may be unable to be receivedwithin cannula 1431 such as shown in FIG. 14L or may be unable to bereceived within an inner cannula of two delivery cannulas as shown inFIG. 14 k . In embodiments comprising two cannulas, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only need to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Such embodiments may be useful for cosmeticprocedures within the skin, for example, but not limited to, for facelifting and/or cellulite treatment.

Some embodiments could be configured to allow for treatment to takeplace from the tip at a non-perpendicular angle relative to the axis ofthe cannula. In some such embodiments, this non-perpendicular angle mayeven allow the tip to be withdrawn in this treatment configuration.Thus, such embodiments may be configured such that some deploymentconfigurations may also be considered treatment configurations. Inalternative embodiments, the lysing tip may be reconfigured to rotate180 degrees allowing for angling of the tip in either direction relativeto the normal of the axis of the cannula. Thus, in this manner a lysingtip could be used to treat in a first lateral direction and also asecond lateral direction opposite to the first lateral direction such asin FIGS. 14 b, 14 k , and/or 14/L.

In the current embodiment, hinges 1427/1428 couple actuation rod pairs1421/1423 and 1422/1424 allowing a pivoting movement in both verticaldirections.

Some embodiments may utilize a protective sleeve 1499 which sleeve 1499may serve to protect the tip (either a lysing tip or tissue modificationtip (TMT)) during deployment such as those depicted in FIGS. 14 k-n . Insome embodiments the protective sleeve 1499 may comprise a biodegradablematerial such as gelatin. Preferably the protective sleeve 1499 ispositioned about the distal end of the tip during deployment. Inembodiments in which the protective sleeve 1499 is biodegradable, thesleeve 1499 may begin to degrade once deployed in the body.Alternatively, the protective sleeve 1499 may not be biodegradable inwhich case the sleeve may be withdrawn from the tip by anotherinstrument. In some embodiments, the sleeve 1499 may be withdrawn bypositioning the sleeve covered tip within the body and then withdrawingthe tip to remove the sleeve. In other embodiments, the lysing tip 1410may be configured to rotate up to 180 degrees to a point to allow thesleeve to be withdrawn. In alternative embodiments, sleeve 1499 maycomprise a weakened seam 1499′ such that when lysing tip 1410 isrotated, the weakened seam 1499′ breaks allowing sleeve 1499 todisengage lysing tip 1410. For example, weakened seam 1499′ may comprisea series of cuts or scorings. In some embodiments, the sleeve 1499 maybe made up of a material configured to utilize body fluids to provide aslippery or non-frictional surface.

In the depicted embodiment, 1447 represents an antenna configured todeliver a signal to a receiver unit. Antennae 1447 may be located withinhole 1455. In some embodiments, antenna 1447 may comprise radiofrequencyidentification (RFID) TAG. In some embodiments the RFID tag may comprisean RFID transponder. In other embodiments the RFID tag may comprise apassive tag. It should be understood that antenna 1447 is not depictedin every one of the other figures; any of the embodiments describedherein may comprise one or more such elements. Other embodiments maycomprise one or more antenna on any other suitable location on theembodiment, including but not limited to on the protrusions or otherwiseon the tip, and on the shaft. In embodiments in which antenna 1447comprises an RFID transponder, the RFID transponder may comprise amicrochip, such as a microchip having a rewritable memory. In someembodiments, the tag may measure less than a few millimeters. In someembodiments a reader may generate an alternating electromagnetic fieldwhich activates the RFID transponder and data may be sent via frequencymodulation. In an embodiment, the position of the RFID tag or otherantenna may be determined by an alternating electromagnetic field in theultra-high frequency range. The position may be related to a 3dimensional mapping of the subject. In an embodiment the reader maygenerate an alternating electromagnetic field. In some such embodiments,the alternating electromagnetic field may be in the shortwave (13.56MHz) or UHF (865-869 MHz) frequency. Examples of potentially usefulsystems and methods for mapping/tracking a surgical instrument inrelation to a patient's body may be found in U.S. Patent ApplicationPublication No. 2007/0225550 titled “System and Method for 3-D Trackingof Surgical Instrument in Relation to Patient Body”, which is herebyincorporated by reference in its entirety.

In some embodiments, a transmission unit may be provided that maygenerate a high-frequency electromagnetic field configured to bereceived by an antenna of the RFID tag or another antenna. The antennamay be configured to create an inductive current from theelectromagnetic field. This current may activate a circuit of the tag,which may result in transmission of electromagnetic radiation from thetag. In some embodiments, this may be accomplished by modulation of thefield created by the transmission unit. The frequency of theelectromagnetic radiation emitted by the tag may be distinct from theradiation emitted from the transmission unit. In this manner, it may bepossible to identify and distinguish the two signals. In someembodiments, the frequency of the signal from the tag may lie within arange of the frequency of the radiation emitted from the transmissionunit. Additional details regarding RFID technology that may be useful inconnection with one or more embodiments discussed herein may be foundin, for example, U.S. Patent Application Publication No. 2009/0281419titled “System for Determining the Position of a Medical Instrument,”the entire contents of which are incorporated herein by specificreference.

In other embodiments, antenna 1447 may comprise a Bluetooth antenna. Insuch embodiments, multiple corresponding Bluetooth receivers at knownlocations may be configured to sense signal strengths from the Bluetoothantenna 1447 and triangulate such data in order to localize the signalfrom the Bluetooth antenna 1447 and thereby locate the lysing tip withina patient's body. Other embodiments may be configured to useangle-based, electronic localization techniques and equipment in orderto locate the antenna 1447. Some such embodiments may comprise use ofdirectional antennas, which may be useful to increase the accuracy ofthe localization. Still other embodiments may comprise use of othertypes of hardware and/or signals that may be useful for localization,such as WIFI and cellular signals, for example.

One or more receiver units may be set up to receive the signal from thetag. By evaluating, for example, the strength of the signal at variousreceiver units, the distances from the various receiver units may bedetermined. By so determining such distances, a precise location of thelysing tip relative to a patient and/or a particular organ or othersurgical site on the patient may be determined. In some embodiments, adisplay screen with appropriate software may be coupled with the RFID orother localization technology to allow a surgeon to visualize at leastan approximate location of the tag/antenna, and therefore the lysingtip, relative to the patient's body.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 1448 may befurther coupled with one or more RFID tags. One or more sensors 1448 maybe located within one or more holes 1455. As such, data from the one ormore sensors may be paired or otherwise used in connection with datafrom the one or more RFID tags or other antennas. For example, someembodiments may be configured to provide information to a surgeonregarding one or more locations on the body from which one or moresensor readings were obtained. In some embodiments, temperature sensorsmay include thermistors and/or thermocouples. To further illustrateusing another example, information regarding tissue temperature may becombined with a location from which such tissue temperature(s) weretaken. In this manner, a surgeon may be provided with specificinformation regarding which locations within a patient's body havealready been treated in an effective manner and thus which locationsneed not receive further treatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 1448 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis.

In alternative embodiments which may be helpful for skin/cosmeticprocedures, the TD tip and/or the anticipated and/or previous paths maybe visualized using for example an internal camera such as an endoscopicor laparoscopic camera, and/or an external camera such as an infraredcamera, (for example, a FLIR camera), an RFID tag or other antenna. Insome implementations, such a device or devices may be positioned on theTD. In other implementations such a device or devices may be separatefrom the TD. A real time display may be created using the data of thecameras and/or antennae and/or tags, for example, showing the exactlocation of the tip and the during- and post-passage temperatureeffects. In alternative embodiments, the software presenting the visualinformation may hold (or slow the decay back to the body temperature)the color (designating temperature) at its maximum value during theremainder of the procedure so that the surgeon will know where the TDtip has been.

In some embodiments, system 1400 may comprise canal(s) 1404 (onlydepicted in FIG. 14 d ) which may be positioned to supply one or morefluids to the surgical site around or near lysing tip 1410 via a portlocated adjacent to the internal device cannula and/or lysing tip. Canal1404 may be configured to be extended and withdrawn as needed. Inalternative embodiments, other fluids that may pass down canal 1404 mayinclude, but not be limited to, cold nitrogen gas, fluorocarbons, etc.,which might cool and/or freeze tissue to alter it in a desired fashion.

FIGS. 14 o-14 t depict an example of a modular lysing tip 1410′comprising a treatment portion 1411′ of lysing tip and a reusable baseportion 1470L. Treatment portion 1411′, which may be disposable in someembodiments, is reversibly coupled with base portion 1470L. Thus, uponcompleting an electrosurgical procedure, the user may remove treatmentportion 1411′, and its accompanying lysing rod 1460 and beads 1451, frombase portion 1470L and reattach a new treatment portion for a subsequentsurgery.

In the depicted embodiment, treatment portion 1411′ may be coupled withbase portion 1470L aligning a seat 1470 u′ formed in upper supportmember 1470 u of treatment portion 1411′ with a locking portioncomprising a pair of opposing flanges 1470 f each of which comprises ahooked end portion 1470 h. Seat 1470 u′ in some embodiments may comprisea narrowed region of upper support member 1470 u. Thus, upon insertingseat 1470 u′ between opposing flanges 1470 f, hooked end portions 1470 hengage an upper surface of upper support member 1470 u in the region ofseat 1470 u′ as depicted in FIG. 14 t . As best illustrated in FIG. 14 r, base portion 1470L may comprise a lower support member configured tomate with upper support member 1470 u such that together they define afull support member as previously described. In addition, because theupper support member 1470 u of treatment portion 1411′ will likely beused only once or otherwise less than base portion 1470L, preferably,holes 1472 and 1473 are formed in base portion 1470L. As previouslydescribed holes 1472 and 1473 may be used to facilitate coupling oflysing tip 1410′ with a deployment assembly as depicted in FIG. 14 o.

After performing an electrosurgical procedure using lysing tip 1410′,upper support member 1470 u may be removed from base portion 1470L by,for example, pulling seat 1470 u′ out of the locking portion of baseportion 1470L. In some cases, a user may pull or pry opposing flanges1470 f apart either by hand or by use of a suitable tool during thisdecoupling process. FIGS. 14 p, 14 s, and 14 t are cross sectional viewstaken at line A-A depicted in FIG. 14 r.

FIGS. 15 a-15 k depict an alternative embodiment of a CDTD system 1500comprising beads 1551 a/b/c/d coupled with a bow/support member 1570 andfurther comprising an energy window made up of a plurality of electrodetermini 1506 a/1506 b/1506 c/1506 d for delivering energy such as RF.Bow/support member 1570 may be coupled to actuation arms 1521 and 1522and delivered through cannulas 1531 and 1532 may be employed. In someembodiments the RF energy delivered by the termini 1506 a/1506 b/1506c/1506 d may be distinct from the RF energy delivered by the lysingsegments between the adjacent beads. Beads may comprise facets 1552 andtunnels 1554. More particularly, in the depicted embodiment, the energywindow comprises an energy window strip 1507 which is preferably made ofa conductive material. Energy window strip 1507 comprises a plurality ofenergy window termini 1506 a/1506 b/1506 c/1506 d protruding from theenergy window strip 1507. An insulation cover 1508 may be configured tobe coupled with energy window strip 1507. In some embodiments insulationcover 1508 may be molded onto energy window strip 1507. Alternativelythe insulation cover 1508 may be configured to receive the energy windowstrip 1507 or otherwise be coupled with energy window strip 1507.Preferably, the insulation cover 1508 comprises a non-conductivematerial. In the depicted embodiments, the insulation cover 1508comprises an elongated base configured to cover the energy window stripbut allow the energy window termini 1506 a/1506 b/1506 c/1506 d toprotrude through the insulation cover 1508. In addition, the insulationcover 1508 comprises a plurality of protruding bead coupling members1508′, each of which is configured to extend into and be coupled withone of the beads of the tip via hole 1555 (as shown in FIG. 15 i , across-sectional view down/through the center of outer bead 1551 d).Energy delivery conduit 1509 such as a wire may be coupled with theenergy window strip 1507. Preferably, the energy delivery conduit 1509is insulated from the energy delivery conduit that delivers energy tothe lysing segments 1561 a/1561 b/1561 c such that a distinct type ofenergy may be delivered therethrough.

In other embodiments, energy window may be configured to utilize energyof different modalities, including, but not limited to, laser, intensepulse light, resistive heating, radiant heat, thermochromic, ultrasound,mechanical, and/or microwave.

In some embodiments, system 1500 may be configured to utilize bipolarradiofrequency energy as depicted in FIGS. 15 j (energy conduits notshown) and 15 k. In the depicted embodiment, each electrode termini maybe physically independent of the other, however, electrode termini pairs1506 a′/1506 c′ and 1506 b′/1506 d′ may each be electrically coupled toa positive energy conduit 1509 n and a negative energy conduit 1509 p,respectively. In some embodiments, the energy conduits may comprisewires.

FIGS. 16 a-16 h depict an alternative embodiment of a CDTD system 1600comprising a plurality of protrusions 1601 and recessions 1602positioned in between adjacent protrusions. System 1600 is structurallysimilar to system 1400, however, system 1600 is a bipolar device. System1600 further comprises first/inner/device cannula 1631 and second/outercannula 1632, the first or both which may be used to deliver lysing tip1610, as previously mentioned. System 1600 is configured for bipolarelectrosurgical energy delivery, has 3 protrusions defined by beadsouter beads 1651 a/1651 b and middle bead 1652, and 2 lysing segments1668 ps/1668 ns defined by two electrically isolated lysing members 1668pm/1668 nm.

In the embodiment of FIG. 16 f , negative lysing member 1668 nm isconfigured to extend through a tunnel 1658 n formed in bead 1652.Similarly, positive lysing member 1668 pm is configured to extendthrough a separate tunnel 1658 p formed in 1652. Positive lysing member1668 pm and negative lysing member 1668 nm may extend from theirrespective tunnels all the way back to an electrosurgical generatorand/or surgical instrument. In other embodiments lysing members 1668pm/1668 nm may instead terminate within bead 1652 or may terminatesomewhere in between bead 1652 and its ultimate electrical coupling withan electrosurgical energy source. For example, in some embodiments, awire or another electrical conductor may be coupled to lysing members1668 pm/1668 nm.

In some such embodiments, the lysing tip comprises means for maintaininga flexible lysing member in a rigid state. Examples of such means mayinclude a weld, melt, crimp, bend, narrowing of tunnel, and the like. Ina more particular example of such a means, protuberance 1668 b may beformed adjacent to one or more of the openings of tunnel 1658 p or 1658n such that lysing members 1668 pm/1668 nm may be pulled through theirrespective tunnels and tightened or kept taught after whichprotuberances 1668 b may be formed to keep their respective lysingmembers in a rigid or substantially rigid state. In another embodiment,bead 1652 may be formed in two pieces and coupled together afterpositioning lysing members 1668 nm/1668 pm through their respectivetunnels. In some such embodiments, the tunnels may be formed at least inpart with a diameter equal to or less than that of lysing member 1668nm/1668 pm such that upon applying both pieces together the lysingmembers may be prevented from being withdrawn from their respectivetunnels.

In FIG. 16 e , the wiring comprising lysing member 1668 p/1668 n hasbeen removed in order to show the actuation rods 1621/1622 from thecannula distally to the lysing tip 1610. Lysing tip 1610, moreparticularly structural member 1670, in the delivery configuration,seats inside groove 1621 a.

An external power cord may bring electrosurgical energy from anelectrosurgical generator to a hand assembly, such as that illustratedin FIG. 1 , system 1600, (which is electrically connected) to lysingmember 1668 pm/1668 nm (which may be insulated through cannula lumen)directly to lysing tip 1610. In this embodiment, each lysing member 1668pm/1668 nm enters its respective tunnel 1658 p/1658 n through the rearof center bead 1652, and exits an opposite side of bead 1652 whereinlysing member 1668 pm/1668 nm, preferably no longer be insulated afterexiting 1652, defines lysing segments 1668 ps/1668 ns whereupon eachenters its respective outer bead 1651 a/1651 b and terminates withinbeads 1651 a or 1651 b as previously described herein via coupling tips1663.

The tip shown in this embodiment has three relative protrusions 1601,lysing members 1668 pm/1668 nm (and associated lysing segments 1668ps/1668 ns), with beads 1651 a/1651 b/1652 pointing along the main axisof the CDTD in treatment configuration. In other embodiments, thebipolar CDTD lysing tip 1610 may have one or more non-axial protrusionsand one or more non-axial relative recessions. In some embodiments, thetip may have between 3 and 100 axial and/or non-axial protrusions and/orrelative recessions. It should be understood that the number ofprotrusions need not match the number of lysing elements or recessions.In some embodiments, lysing elements may be located at the termini ofconductive elements. In some embodiments, lysing elements may also bemade partially or completely of a cermet material. In an embodiment, themodular bipolar CDTD tip 1610 may measure about 15 mm in length (TL inFIG. 10 e ) and/or about 3 mm in height (TH in FIG. 10 d ). Embodimentsare contemplated wherein sizes of about one-fifth to about five timesthese dimensions may have possible uses. It is also contemplated, forexample in some veterinary embodiments, tip sizes of about one-tenth to20 times the aforementioned dimensions may have possible uses. In othercontemplated embodiments, electroconductive leads may course from anelectrosurgical generator via first/inner/device cannula 1631 toenergize various lysing elements located in bipolar CDTD tip 1610. Insome embodiments leads may comprise wires and/or conductive conduits.

FIG. 16 g is an anterior elevated perspective view of lysing tip 1610.In this embodiment, individual lysing segments 1668 ps/1668 ns maycomprise surgical grade conductive metals and/or alloys positionedwithin all and/or a portion of one or more pieces of ceramic and/orother thermally resistant, non-conductive housing. In some embodiments,one or more individual lysing elements/segments may compriseelectroconductive materials including but not limited to cermets, steel,nickel, alloys, palladium, gold, tungsten, titanium, silver, copper,and/or platinum. In the depicted embodiment, the lysing elements maymeasure about 2 mm in length, and about 0.5 mm in diameter/thickness.

In this embodiment, the configuration of the tunnels in the end beadsmay capture corresponding elements as described in previous embodiments.For example, certain beads may comprise hole 1655 that may be positionedperpendicular to lysing rod hole 1658; holes 1655 may be available as aplatform/location to add other features/components such as providing alocation for coupling of a cord as described below in connection withother embodiments and/or locating a sensor and/or RFID locationcomponent and/or being used for placement of luminescent and/or lightproduction element(s) for visualization, for example, tritium and thelike.

In some contemplated embodiments there need not be equal numbers ofoppositely signed and/or charged individual lysing elements. Uniformityof flux on activation may be achieved by modifying the size and/orposition of lysing elements with respect to each other among othermethods known in the art.

The relative static permittivity of some ceramics may range from about 5to 10; this may cause some leakage of current in an undesirable pathbetween closely approximated opposing electrodes during activation. Useof other materials, for example, those having over of relative staticpermittivities of 5 may undesirably alter the resultant plasma field.The relative static permittivity of the intervening materials housingthe opposing electrodes may be enhanced by coating and/or surroundingand/or injection molding thermoresistant polymers of a low relativestatic permittivity into the housing and/or around one or more portionsof bipolar lysing segments 1668 ns/1668 ps to reduce the effectivestatic permittivity of the tip. In an embodiment, the thermoresistantpolymer of low relative static permittivity 2.1 may bepolytetrafluoroethylene. In other contemplated embodiments,thermoresistant polymers may include polyether etherketone (@3.3) and/orpolysulfone (@3.1) and the like may be useful.

In the depicted embodiments, the electrical insulator on lysing member1668 nm/1668 pm and/or support member 1670 may comprisepolytetrafluoroethylene. In other contemplated embodiments, theelectrical insulator may comprise an electrically nonconductive polymerwith a high melting temperature. In some embodiments, the nonconductivepolymer may comprise for example, polyether etherketone and/orpolysulfone, etc. In other contemplated embodiments, the electricalinsulator may comprise an electrically nonconductive and/or thermallynonconductive polymer.

In some embodiments and implementations, lysing tip 1610 may beconfigured such that its beads 1651 a/b and 1652 are too large to fitwithin the lumen of first/inner/device cannula 1631, even in thedelivery configuration. Thus, lysing tip 1610 in its deliveryconfiguration may be positioned just outside (immediately distal) offirst/inner/device cannula 1631 but within second/outer cannula 1632during delivery.

FIGS. 17 a-17 m depict yet another embodiment of a CDTD or a non-CDTDsystem 1700. System 1700 comprises a lysing tip 1710 that is configuredto be completely separable from any other element of the system. In thismanner as depicted in FIGS. 17 f-g , lysing tip 1710 may be deliveredthrough a first/primary cannula 1732, which may comprise, for example, atrocar, and then coupled with a first surgical tool, such as agrasping/control instrument 1790 that can be used to control and/orenergize the lysing tip 1710 within the body of a patient during asurgical procedure. In some embodiments and implementations, a secondcannula may be used to deliver a second surgical tool, such as atransfer/grasping instrument 1796, that may be used to facilitatecoupling of lysing tip 1710 to the grasping/control instrument 1790,which instrument may be delivered through the same cannula 1732 throughwhich the lysing tip 1710 is delivered. In some embodiments,grasping/control instrument 1790 may have the same configuration asgrasping/transfer instrument 1796. In alternative embodiments,transfer/grasping instrument 1796 may be configured differently fromgrasping control instrument 1790 in that, for example, it may not havethe capability to transfer energy to lysing tip 1710 yet may have adifferent tip design in order to facilitate grasping/holding lysing tip1710 between two beads or other protrusions. Alternatively, the lysingtip 1710 may be delivered though a second unattached cannula 1735 alongwith a grasping/transfer instrument 1796 used to couple the lysing tip1710 to the first surgical tool delivered through the first/primarycannula, which other surgical tool may be used to control lysing tip1710 and perform the surgical procedure. As shown in the FIG. 17 f ,lysing tip 1710 is positioned within outer cannula 1732 with an axisextending between the outermost beads 1751 a/1751 d in lysing tip 1710aligned with a primary axis of cannula 1732 and with a treatment side oflysing tip 1710 (opposite from grasping pad 1771) facing an internalsurface of cannula 1732.

In some implementations of methods using system 1700, the lysing tip maybe reconfigured from a delivery configuration to a treatmentconfiguration by delivering lysing tip 1710 through a cannula at leastsubstantially along a treatment axis of the lysing tip extending betweenopposing outer beads and then rotating the lysing tip once outside thedistal end of the cannula. In some such implementations the step ofreconfiguration the lysing tip from delivery to treatment configurationmay further comprise grasping a portion of the lysing tip such as thegrasping pad in a manner such that the treatment axis is at leastsubstantially perpendicular to an axis of the grasping instrument. Thus,the lysing tip may be grasped from a direction at least substantiallyperpendicular to the grasping direction in the treatment configurationduring delivery.

In alternative implementations, a standard 3-5 mm diameter graspinginstrument with handle (without a lysing tip attached) may be directedinto the body cavity, possibly via a trocar of accepting diameter or viaan incision in the skin, and exit extracorporeally via another trocar(for example, of larger diameter at umbilicus), whereupon the graspermay open its and receive the lysing tip at an angle that permits thegrasper to pull lysing tip into the body cavity through the largertrocar. Once inside the body cavity, the lysing tip may be reconfiguredfrom a delivery configuration to a treatment configuration.

Lysing tip 1710 may comprise a plurality of protrusions 1701 comprisingbeads 1751 and recessions 1702 between each bead pair. Lysing member1760, which in the depicted embodiment comprises a lysing rod 1760enclosed by spacers 1762 a/1762 b/1762 c positioned in recessions 1702,delivers electrosurgical energy. Each of the portions of lysing member1760 extending between adjacent beads 1751 may be considered lysingsegments 1760 a/1760 b/1760 c. In the depicted embodiment, each of thelysing segments or spacers 1762 a/1762 b/1762 c is collectively definedby a single lysing member 1760. However, other embodiments arecontemplated in which separate lysing members may be used for each ofthe lysing segments positioned between adjacent beads. FIG. 17 c depictslysing tip 1710 with bead 1751 c removed in order to show internalcomponents and to show tunneling within outer beads 1751 a and 1751 d.

In FIG. 17 j , spacers 1762 a/1762 b/1762 c may be removed and replacedwith protuberances 1765 a/1765 b positioned on opposing sides of one ormore of the beads, such as middle bead 1751 b, as a means to inhibit orlimit the lateral movement of middle bead 1751 b and/or any other beads,as desired. Additionally depicted in FIG. 17 j is an embodiment in whichlysing rod 1760 is roughened or otherwise deformed between points 1767Land 1767R. In some such embodiments, this may be done by adding materialto the lysing rod and/or adding material to the inside of the beadtunnel 1754 in a manner that the diameter of sufficient portions oflysing rod 1760 is increased to or slightly greater the internaldiameter of tunnel 1754 of bead 1751 c such that when bead 1751 c isslid into its position between points 1767L and 1767R, bead 1751 c maytend to remain in place via friction fit. Alternatively, the portions oflysing rod 1760 configured to extend through bead tunnel 1754 may beroughened by removing material from lysing rod 1760 such as by sandingand/or blasting. In these configurations, lysing rod 1760 may also actas the lysing segments. In FIG. 17 j . although both protuberances andfriction fit are shown and spacers removed, this is done primarily forpurposes of illustration, thus, as those of ordinary skill in the artwill appreciate, in practice, only one of the options may likely beused. The roughening described herein may be useful for example in orderto prevent or inhibit rotation of the beads on the lysing rod. In someembodiments, the amount of roughening may be used selectively to selectthe amount and/or ease of rotation.

In alternative embodiments, hole 1055 d′ may be moved to fully orpartially intersect tunnel 1054 thus allowing communication with lysingrod 1060; thus a weld, plug (for example 1055 p), glue, insert or othermethod of fixation may be inserted via hole 1055 d′ to attach to lysingrod 1060 thus restricting lateral movement of a bead. To reduce escapeof electrosurgical energy through hole 1055 d′, an insulator comprisedof epoxy, plastic, ceramic or the like may be placed in part or all ofthe remaining hole 1055 d′. This alternative embodiment may be appliedto other embodiments herein.

FIG. 17 k illustrates a front/elevation view of an alternativeembodiment in which lysing tip 1710 may be configured without a solidlysing rod and/or without spacers and/or welds (that may face distally,proximally, or therebetween) and the like. In such embodiments, internalbead tunnels 1754 and support member holes 1767 a/1767 b may beconfigured to accommodate hollow lysing rod 1760 a. Between beads,hollow lysing rod 1760 a may be deformed 1760 a′ in a manner to preventlateral movement of beads and/or prevent rotation of beads, as shown inFIG. 17 k . Hollow lysing rod 1760 a′ may be deformed minimally or to apoint that it is substantially flat. In such embodiments, it may bepreferable for the front edge to point distally as the leading frontedge. In such embodiments, screw 1709 may secure one or both ends of thehollow lysing rod 1760 a within outer beads 1751 a/1751 d. Inalternative embodiments, hollow lysing rod 1760 a may be replaced withsolid lysing rod 1760 and deformed adjacent to middle beads in themanner suggested in this paragraph. The configurations of thisalternative embodiment may be available for any other similar embodimentcontemplated herein.

In alternative embodiments that may comprise lysing rod 1760, spacers1762 a/b/c may be deformed on the lysing rod 1760 so as to becomeimmovable, either in addition to deforming the lysing rod itself or asan alternative to deforming the lysing rod.

As previously mentioned, beads 1751 may be coupled with one another byway of a single lysing member 1760 extending through tunnels 1754extending through each of the respective beads 1751. In the depictedembodiment, beads 1751 each comprise a non-symmetrical shape and/or maybe eccentric relative to tunnels 1754. However, in this embodiment, asshown in the figures, the opposing outer beads 1751 a and 1751 d have ashape that differs from the shape of the beads in between the outerbeads, namely beads 1751 b and 1751 c Of course, as previouslymentioned, in some embodiments, all of the beads may have the same, orsubstantially the same, shape/size. In other embodiments, each of thebeads may have a different shape to accommodate a particular type ofsurgery, for example. More particularly, beads 1751 b and 1751 c have asimilar distal or frontal shape (from the perspective of the treatmentside of tip 1710) but have a flattened, thus shorter, rear end so as toaccommodate a support member 1770, which in this embodiment comprises abow 1770. Support member, as described in greater detail below, may beused to facilitate temporary coupling of lysing tip 1710 to a surgicaltool, such as a driver. In some embodiments, support member 1770 mayalso be used to facilitate delivery of electrosurgical energy intolysing tip 1710. Support member 1770 may be preferably fully orpartially insulated, except for regions on which it is desired totransfer electrosurgical energy such as (1) at one or more surfaces ofgrasping pad 1771, (2) within the 2 distal support member holes (asshown in FIG. 17 e, 1767 a /1767 b), and/or (3) the opposing distal endsof support member 1770, in some cases distal of lysing rod 1760 in orderto deliver electrosurgical energy not only through lysing rod 1760 butalso through these distal ends of support member 1770. Support member1770 may be fully or partially insulated in order to preventelectrosurgical energy from transferring to tissue from the supportmember 1770; more particularly, insulating support member 1770 directselectrosurgical energy to lysing member 1760 through support memberholes 1767 a/1767 b. In some embodiments, support member 1770 maycomprise for example a non-conductive material such as a ceramic and/orflexible ceramics (for example, “Flexiramics®”). In some suchembodiments, one or more electrical conduits such as a wire may beembedded within and/or extend through or otherwise be coupled with thesupport member 1770 so as to deliver electrosurgical energy to lysingmember 1760.

Support member 1770 may be used to provide a frame or support structurefor lysing tip 1710 and/or used to provide a feature, such as graspingpad 1771. In the depicted embodiment, the grasping pad 1771 is definedin part by a tab 1771 a, to allow an endoscopic tool having a graspingtip, such as grasping tip jaws 1796 a/1796 b of grasping/controlinstrument 1790, to grasp and manipulate lysing tip 1710. If the tipends of support member 1770 are coated with nonconductive insulation,such coating might increase the width of relative protrusion 1701 andperform similar to a protrusion bluntly dissecting/separating tissues,however, if said tips are not so coated, the area of relative protrusion1701 may be limited to what is illustrated as said tip may perform in amanner similar to lysing rod 1760 cutting and/or coagulating tissues.

Support member 1770 in the current embodiment comprises a bow shapecomprising two opposing end tips comprising holes or other openingsthrough which lysing rod 1760 extends. The two tips of support member1770 may extend far enough distally to provide sufficient material toform the lysing rod through-holes. Alternatively, openings comprisingslots or the like may be formed at one or both of the two opposing tipsof support member 1770 if desired.

In the depicted embodiment, the tunnels 1754 are positioned in anon-central location within each of beads 1751. More particularly, thetunnels 1754 in this particular embodiment are positioned in a forwardor distal location relative to a central axis of each of beads 1751,including outer beads 1751 a and 1751 d, which may have a ellipsoidal orsimilar shape, and internal beads 1751 c and 1751 d, which may have asimilar ellipsoidal front tip but have a flattened and/or shortened rearend, as shown in the figures. As previously mentioned, this may bepreferable for some embodiments, particularly embodiments in which beads1751 can at least partially rotate on the lysing rod or other lysingmember 1760 to allow the lysing tip 1710 to be directed through tissuein a desired manner.

Preferably, the entire surfaces of the beads 1751, or at least outerbeads 1751 a and 1751 d, may be smooth. Or, at least all surfaces thatmay be expected to contact tissue during a surgical procedure may besmooth. For example, providing a smooth front end and a smooth trailingend may allow the lysing tip to be moved in a forward direction and thenin a rearward direction back and forth without catching an undesirableamount of tissue on beads to inhibit such movement. However, as shown inFIGS. 17 a-17 m , in some embodiments, the trailing end of some beads,such as internal beads 1751 b and 1751 c, may comprise a flat surfacesuch that each internal bead comprises a frusto-shaped or anothersimilar shape. In other contemplated embodiments, providing a roughtrailing end may create frictional drag on that portion of the bead thushelping reorient the front end of the bead for further tissue passage.Thus, in some embodiments, the trailing end may have a rougher surfacethan the front end. Preferably, at least the forward or distal surfaceof each bead is smooth and defines a substantially and/or partiallyellipsoidal shape or another shape having a smooth forward surface. Inalternative embodiments, the distal/forward tip of beads 1751 may have amore narrowed end to act more as a wedge for purposes of acting as ablunt dissector between tissues and tissue planes. The forward tips maybe narrowed by use of facets (such as those facets 1052 in FIG. 10 d ).Facets are preferably formed on the distal/front/leading portions of thebead to facilitate tip movement through/between tissue layers. Asdescribed in FIGS. 12 aa-rr, a wide variety of alternative bead shapesare possible including, for example, ovoid shapes, spherical shapes,wheel shapes, bullet shapes or other shapes having a flat terminal end(such as, for example, frusto-ellipsoidal), wing shapes, etc. In someembodiments, beads may be faceted on the top, bottom, sides, frontand/or back such as illustrated in FIGS. 10 c /10 d, at facet 1052.

As previously mentioned, in some embodiments, it may be desirable toallow beads 1751 to rotate, at least partially, on lysing member 1760.Thus, beads 1751 may not be fixed three-dimensionally with respect tolysing member 1760 and/or one or more other elements of lysing tip 1710.In some such embodiments, beads 1751 may be at least partially rotatablewith respect to the remainder of lysing tip 1710. In embodiments inwhich beads 1751 are rotatable in this manner, it may be desirable touse a lysing member having a circular cross section. It may also bedesirable to form spacers 1762 a/1762 b/1762 c in ways that facilitatesuch rotation and/or restrict it in some manner. Thus, in someembodiments, one or more of spacers 1762 a/b/c may also be rotatablewith respect to lysing member 1760. In some such embodiments, spacers1762 may be configured to rotate with beads 1751.

In the depicted embodiment, each of the spacers 1762 a/b/c is positionedabout one of the respective lysing segments defined by lysing member1760 which may be configured to space the various beads 1751 apart,provide stability to the lysing tip, and/or protect the respectivelysing segments (which, in the depicted embodiment, are collectivelydefined by a single lysing member 1760). Preferably, spacers 1762 a/b/ccomprise a conductive material, such as a suitable biocompatible metal,that can receive electrosurgical energy from the lysing member 1760 anddeliver it to various internal body tissues during a surgical procedure.Preferably, spacer(s) 1762 a/b/c are therefore in direct contact in oneor more pre-determined locations on lysing member 1760. In otherembodiments, a single spacer may both extend between the various beads1751 and extend through the tunnels through the beads 1751 rather thanusing separate spacers for each lysing segment.

One or more of the beads 1751, such as preferably one or both of theouter beads 1751 a and 1751 d, may further comprise a hole 1755. Hole(s)1755 may, together with a cord 1744 (which may be a suture), forexample, comprise an example of means for maintaining retrievability ofa free-floating lysing tip when the lysing tip is decoupled from agrasping/control instrument. In preferred embodiments and/orimplementations, cord 1744 or another loopable element may be loopedthrough one or more such hole(s) and then may extend through one or morecannulas used to deliver lysing tip 1710 proximally back to a surgeon.In this manner, in the event of a failure to grasp or otherwise couplelysing tip 1710 to a grasping/control instrument, such asgrasping/control instrument 1790, lysing tip 1710 may be retrieved fromwithin a patient's body by pulling on suture 1744 to retract lysing tip1710 though cannula 1732. In some embodiments, hole 1755 may also oralternatively be used to maintain position of lysing tip 1710 whileawaiting delivery of a grasping/control instrument 1790 for performingsurgical procedures. Upon properly coupling lysing tip 1710 with anappropriate tool for grasping and/or controlling lysing tip 1710, suchas grasping/control instrument 1790, a surgeon may cut suture 1744,preferably near a knot or other feature used to form a loop around hole1755. If a suture 1744 or other similar material/element is used that issufficiently flexible and non-disruptive, this shorter loop may beconfigured to be present during a surgical procedure using lysing tip1710 without unduly interfering with the procedure. In alternativeembodiments, holes 1755 may be available as a platform/location to addother features/components such as providing a location for coupling of acord as described below in connection with other embodiments and/orlocating a sensor and/or RFID location component and/or being used forplacement of luminescent and/or light production element(s) forvisualization, for example, tritium and the like. In alternativeembodiments, hole 1755′ may be moved to fully or partially intersecttunnel 1754 thus allowing communication with lysing rod 1760; thus aweld, plug, glue, insert or other method of fixation may be inserted viahole 1755′ to attach to lysing rod 1760 thus restricting lateralmovement of a bead and/or rotation of the bead with respect to lysingrod 1760. However, in some embodiments one or more of the beads alongwith the lysing rod 1760 may be configured to rotate at least partiallywith respect to the support member 1770. To reduce escape ofelectrosurgical energy through hole 1755′, an insulator comprised ofepoxy, plastic, ceramic or the like may be placed in part or all of theremaining hole 1755′. This alternative embodiment may be applied toother embodiments herein.

Preferably, lysing member 1760 terminates within outer beads 1751 a and1751 d. Thus, it may be desirable to melt, tip, ball, crimp, fold, tie,or otherwise couple the ends of lysing member 1760 within outer beads1751 a and 1751 d at opposing lysing member coupling tips 1763 a and1763 b. Preferably, lysing tip 1710 is configured such that each ofbeads 1751 are rotatable independent of one another. However, dependingupon how opposing lysing member coupling tips 1763 a and 1763 b areconfigured, rotation of outer bead 1751 a may transfer, at least to acertain extent, to outer bead 1751 d, and vice versa.

In some embodiments, it may be desirable to provide features and/orelements that inhibit or limit the ability of the electrosurgical energyto discharge from the opposing ends of the lysing rod 1760 at couplingtips 1763 a/b. Thus, in some such embodiments, coupling tips 1763 a/bmay be coated or covered with a suitable insulating material such as anepoxy with non-conductive properties. Alternatively, outer bead hole1754 at the end with the larger-opening may be capped or plugged with anelement configured to be received or otherwise engage the larger openingof the bead. Preferably, this element will have non-conductiveproperties similar to the insulating material previously referenced.

Coupling tip 1763 a/1763 b may be configured to engage a ledge 1759positioned at a transition point between two concentric tunnels (1759a/1759 b), more particularly, outer tunnel 1759 b may comprise a largerdiameter or other cross-sectional dimension than inner tunnel 1759 asuch that lysing member 1760 may extend through inner tunnel 1759 a butcoupling tip 1763 a due to its larger size may be configured to extendthrough outer tunnel 1759 b without passing through inner tunnel 1759 a.In other embodiments, there may be a single tunnel 1759 c that tapersfrom a larger dimension on the outer side of bead 1751 to a smallerdimension toward the inside of the bead relative to the lysing tip 1710.

As shown in FIG. 17 a , grasping pad 1771 of support member 1770 may besituated along a central portion of support member 1770 along the rearor proximal end of lysing tip 1710. In some embodiments, grasping pad1771 may comprise a plate with opposing flattened surfaces configured toallow a surgical tool with a grasping tip, such as jaws 1796 a and 1796b in FIGS. 17 f and 17 g , to grasp and/or manipulate/control supportmember 1770 and therefore lysing tip 1710.

In some embodiments, at least a portion of support member 1770 and/orgrasping pad 1771 may comprise a conductive material and support member1770 and/or grasping pad 1771 may be configured to receiveelectrosurgical energy, such as from a grasping/control instrument 1790or another surgical tool, and deliver such energy to lysing member 1760.For example, in some such embodiments, electrosurgical energy may bedelivered through grasping jaws 1793 a/1793 b, into grasping pad 1771,down through the frame of support member 1770, and into lysing member1760. In other embodiments, grasping pad 1771 may be insulated andelectrosurgical energy may instead be delivered to lysing tip 1710 inanother manner.

FIGS. 17 a-e illustrate a tab 1771 a extending distal from grasping pad1771, which comprises an extended central region. Such central regionmay be useful to allow for greater surface area for grasping by jaws orother elements of a grasping tip from a surgical tool, such as jaws 1796a/1796 b of grasping/control instrument 1790.

In embodiments comprising a free-floating lysing tip (can be uncoupledfrom any control instrument or cannula), including the embodiments ofFIGS. 17-31 and 35-38 , certain preferred embodiments may have a size ofabout 12 to 18 mm from the end of one protrusion and/or bead to theopposite protrusion/bead on the opposite end; the length of the largestouter beads (BL as illustrated in FIGS. 10 d /10 e) may range from about3 mm to 12 mm; the height BH as illustrated in FIGS. 10 d /10 e) of thelargest outer beads may range from 2 mm to 10 mm. In some embodiments,this dimension may be defined by the distance from the upper end of oneor more (in some embodiments, each) beads to the lower end of one ormore beads. In some free-floating embodiments, the lysing tip may have awidth TW as illustrated in FIGS. 10 d /10 e) of about 4.5 mm from theproximal end of the lysing tip to the distal end of the lysing tip.However, it should be understood that a wide variety of alternativeshapes and/or sizes may be usable depending upon the particular surgicalprocedure involved.

Similarly, in embodiments comprising a fixed lysing tip (coupled to oneor more actuation rods), certain preferred embodiments may have a sizeof about 15 mm from the end of one protrusion and/or bead to theopposite protrusion/bead on the opposite end, may have a size of about 3mm from the upper end of the lysing tip to the lower end of the lysingtip. In some embodiments, this dimension may be defined by the distancefrom the upper end of one or more (in some embodiments, each)protrusions/beads to the lower end of one or more protrusions/beads. Insome free-floating embodiments, the lysing tip may have a size of about3.5 mm from the proximal end of the lysing tip to the distal end of thelysing tip. However, it should be understood that a wide variety ofalternative shapes and/or sizes may be usable depending upon theparticular surgical procedure involved.

In FIGS. 17 h-i , a non-conductive sheath 1795 may be deployed to coverthe outer surface and/or conductive surfaces of shaft and tip/jaws 1793a/1793 b of grasping/control instrument 1790 to electrically isolate theelectrically conductive surfaces of grasping/control instrument 1790. Inthe current embodiment, conducting wire 1768 may carry electrosurgicalenergy from the energy source to lysing tip 1710. In other embodiments,the embodiment of FIG. 17 h /17 i may also have an insulated graspingpad 1771, since wire 1768 is provided for delivery of electrosurgicalenergy. In other contemplated embodiments, sheath 1795 may electricallyisolate the grasping control instrument, but permit electrical contactbetween the jaws of grasping control instrument 1790 and the graspingplate of lysing tip 1710. However, it should be understood that theshape of grasping pad 1771 may be used in conductive or non-insulatedembodiments.

FIG. 17 b is a cross-sectional view taken along line 17 b-17 b in FIG.17 a illustrating spacer 1762 b, middle bead, 1751 b, support member1770, and lysing rod 1760. FIG. 17 e is a perspective view of supportmember 1770 (and grasping pad 1771) comprising holes 1767 a/1767 bthrough which lysing rod 1760 extends and comprises coupling tips 1763a/1763 b on its opposing ends.

An alternative system for use of a lysing tip 1714 t with a modulargrasping instrument tip 1714 g is shown in FIGS. 17L and 17 m. In someembodiments, modular instrument tip 1714 g and lysing tip 1714 t may bepermanently coupled to one another as described below. Alternatively, inother embodiments lysing tip 1714 t may be removable from modularinstrument tip 1714 g. When the instrument tip 1714 g and lysing tip1714 t may be combined, they may be referred to herein as a modulargrasper/tip 1714. Modular instrument tip 1714 g comprises a lockinglumen 1799′ that is configured to be coupled with a distal end of apushrod 1797 and shaft 1796 of a modular grasping/control instrument 90.

In an example of a procedure using the system of FIG. 17L, a surgeon mayinitially place a trocar 1732′ at a desired location such as through anincision 6′ positioned through the umbilicus 5. A second incision 6,which may be a smaller incision than incision 6′, may be made at alocation spaced apart from incision 6′. In some embodiments andimplementations, incision 6 may be between about 2.5 and about 5 mm.Shaft 1796 of instrument 90 may then be extended through incision 6 andthen subsequently through incision 6′ and trocar 1732′. Modular graspinginstrument 1714 g may then be coupled with the distal end of shaft 1796and push rod 1797. Once lysing tip 1714 t is coupled with modulargrasping instrument tip 1714 g, instrument 90 may then be pulledproximally to introduce lysing tip 1714 t within patient 4. Inembodiments in which lysing tip 1714 t is removable from modulargrasping instrument tip 1714 g, lysing tip 1714 t may be coupled withthe distal end of instrument tip 1714 g prior to proximally pullinginstrument 90 and its distal tip back into the cavity of human or animalbody 4. Once modular instrument tip 1714 g has been coupled withinstrument 90, handle 91 may be used to control one or more aspects oflysing tip 1714 t. For example, actuation of handle 91 may result inlocking lysing tip 1714 t at a particular rotational orientationrelative to shaft 1796 as described in connection with FIG. 17M.Alternatively, handle 91 or another actuation element of instrument 90may be used to rotate lysing tip 1714 t between delivery and treatmentconfigurations. Instrument 90 may also be used to deliverelectrosurgical energy to lysing tip 1714 t. For example, as shown inFIG. 17L, energy connector 92 which may comprise a conductive post maybe used to facilitate an electrical connection with an electrosurgicalgenerator. The electrosurgical energy from this generator may extendthrough shaft 1796 via pushrod 1797 and be coupled with one or morelysing members of lysing tip 1714 t as previously described.

FIG. 17M depicts a more detailed view of the interface between modulargrasping instrument 1714 g and distal tip of shaft 1796 and pushrod 1797of instrument 90. As shown in this figure the distal end of shaft 1796may comprise a locking feature 1798. Locking lumen 1799′ within modularinstrument tip shaft 1794 comprises a slot 1799 s configured to receivelocking feature 1798 at a predetermined rotational configuration. Uponaligning locking feature 1798 with slot 1799 s, shaft 1796 and pushrod1797 may be advanced into locking lumen 1799′. After advancing shaftlocking feature 1798 to its terminal end 1798′ within coupling rod 1792,upon rotation 2 of modular instrument tip shaft 1794, locking feature1798 securely couples shaft 1796 to coupling rod 1792. During the sametime period, pushrod 1797 and its accompanying pushrod locking feature1799 n was advanced to a locking chamber 1799 n′ in which pushrod 1797and its accompanying pushrod locking feature 1799 n may have beenrotated to lock pushrod locking feature 1799 n in place within lockingchamber 1799 n′. In some embodiments, the extent of the rotation ofpushrod locking feature 1799 n may be the same as the extent of rotationof locking feature 1798 which may in some embodiments be 90 degrees. Insome embodiments, pushrod locking feature 1799 n may comprise a plate oran elongated box or any other feature not having rotational symmetryabout the axis pushrod 1797. Locking chamber 1799 n′ may comprise forexample a box or other similar feature given to engage pushrod lockingfeature 1799 n upon rotation of pushrod 1797.

Locking chamber 1799 n′ is coupled with coupling rod 1792 which in turnmay be coupled with one or both jaws. Thus, upon advancing or retractingpushrod 1797, coupling rod 1792 advances or retracts to open or closethe jaws so as to capture support member 1770 within jaws 1793 a (notshown)/1793 b.

Any of the preliminary steps for coupling a lysing tip with aninstrument and/or inserting the lysing tip into a patient discussed inconnection with FIGS. 17L and 17 m may be performed in connection withany of the surgical methods described in connection with FIGS. 40-50 .

FIGS. 18 a-18 e depict another embodiment of a CDTD system or a non-CDTDsystem. Although, other embodiments are contemplated in which system1800 may comprise a CDTD system. System 1800 comprises a lysing tip 1810that is configured to be completely separable from any other element ofthe system. Lysing tip 1810 may comprise a plurality of protrusions 1801comprising beads 1851 a-d and recessions 1802 between each bead pair.Lysing member 1860, which in the depicted embodiment comprises a lysingrod 1860, is enclosed or may be partially enclosed by spacers 1862a/1862 b/1862 c positioned in recessions 1802, delivers electrosurgicalenergy. Each of the portions of lysing member 1860 extending betweenadjacent beads 1851 may be considered lysing segments as discussedpreviously herein. In the depicted embodiment, each of the lysingsegments or spacers 1862 a/b/c is collectively defined by a singlelysing member 1860. However, other embodiments are contemplated in whichseparate lysing members may be used for each of the lysing segmentspositioned between adjacent beads. Spacers may be configured and/orattached as described and illustrated in FIGS. 18 a-18 e to immovablyfix spacers 1862 a/b/c on a lysing rod 1860.

Spacers 1862 a/1862 b/1862 c may be coupled with lysing rod 1860 by, forexample, sliding spacers 1862 a/b/c comprising a lumen along the axis oflysing rod 1860. Alternatively, spacers 1862 a/b/c may be coupled withlysing rod 1860 by placing spacers 1862 a/b/c over lysing rod 1860 in adirection perpendicular to the axis of the lysing rod at a desiredlocation using a slot or other opening formed along a portion of aperimeter spacer 1862 a/b/c. In some embodiments and implementations,spacers 1862 a/b/c (two of a potential three shown in FIG. 18 c ) may becrimped or otherwise fixedly coupled with lysing rod 1860 at a desiredlocation. In some embodiments, this fixed coupling may be configured toprevent the relative movement between lysing rod 1860 and spacer 1862a/b/c possibly reducing hot spots caused from high current density flowin certain areas between lysing rod 1860 and spacer 1862 a/b/c. Theseexemplary methods for applying spacers to a lysing rod and/or anotherlysing member may be apply to any of the other embodiments utilizingspacers.

In some contemplated embodiments spacers may be comprised of insulatingmaterials (such as ceramic, glass, plastic and the like) that may haveholes and/or be porous and/or have breaks and/or have separations suchthat energy from lysing member(s) within may be released into targettissues to have effect such as that illustrated in FIG. 12 j.

In some such embodiments, beads 1851 may be at least partially rotatablewith respect to the entire lysing tip 1810. In embodiments in whichbeads 1851 are rotatable in this manner, it may be desirable to use alysing rod having a circular cross section. It may also be desirable toeither omit spacers 1862 a/b/c or form them without the beveled edgesbest shown in FIGS. 12 h, 12 n , etc.

Spacers 1862 a/b/c may be used to prevent rotation of beads 1851 or toselectively limit the amount of rotation of beads 1851 on a lysingmember 1860. For example, if spacers 1862 a/b/c extend the entiredistance or at least substantially the entire distance between eachadjacent bead, spacers may prevent rotation or, depending upon thedistance between spacers and adjacent beads, may be used to allow for apredetermined amount of such rotation. Similarly, the opposing ends ofspacers 1862 a/b/c may be shaped to match or at least substantiallymatch the shape of the adjacent bead(s) again to either prevent orcontrol rotation.

System 1800 differs from system 1700 only in the manner as to how lysingtip 1810, specifically at grasping plate 1871, is grasped bygrasping/control instrument 1890. Specifically, in FIGS. 18 a-e , thegrasping/control instrument 1890 comprises a tip with upper jaw 1893 aand lower jaw 1893 b, configured in such a manner to create, when shut,a receiving slot 1897 into which the grasping pad 1871 of support member1870 may be grasped. The dimensions of the receiving slot 1897, such asthe width and/or height of receiving slot 1897 may correspond with thedimensions of the support member 1870 at its grasping pad 1871 such thatthere will be a rigid coupling between the jaws and support memberduring the surgical procedure. FIG. 18 d illustrates ledge 1859 withinbead 1851 which may engage coupling tips positioned on opposing ends oflysing rod 1860. Support member 1870 may be preferably insulated, exceptwithin its holes, to prevent unwanted delivery of electrosurgical energyto tissues; thus, electrosurgical energy is directed to support memberholes at which lysing rod 1860 becomes energized for energy delivery.

In this embodiment, facets 1852 may be positioned at the distal ends ofthe beads and the configuration of the tunnels in the end beads maycapture corresponding elements as described in previous embodiments. Forexample, certain beads may comprise hole 1855 that may be positionedperpendicular to lysing rod hole 1858; holes 1855 may be available as aplatform/location to add other features/embodiments (for example,antennae 1847 and/or sensor 1848) and/or to be used for cord/sutureattachments for lysing tip manipulation and/or removal and/or be usedfor placement of luminescent and/or light production for visualization,for example, tritium and the like.

This description is intended to apply to holes in other embodimentsherein similar to 1855.

In FIGS. 19 a-d , an alternative structure for the support member 1970of lysing tip 1910 is depicted, however, all other features of theembodiments depicted in all FIG. 17 and FIG. 18 may be the same inregards to or may apply to the embodiment depicted in FIG. 19 . In FIG.19 , support member 1970 comprises a grasping pad 1971 with tab 1971 a,however, in the depicted embodiment, grasping pad 1971 comprises anopening 1973 which may be either a blind hole or a through-hole. Opening1973 may be configured to receive a corresponding projection 1996 aformed on one or both of jaws of the tip of a grasping/controlinstrument, such as that in FIG. 19 b , jaws 1993 a/1993 b, tofacilitate a secure coupling during the surgical procedure. In addition,corresponding projection 1996 a may be used to deliver energy fromgrasping/control instrument 1993 directly to the opening 1973 of supportmember 1970 which may be especially beneficial if jaws 1993 a/1993 b andgrasping pad 1971 are coated with non-conductive insulation andprojection 1996 a and the tunnel of opening 1973 are not so coated witha non-conductive coating. Thus, in some embodiments projection 1996 amay comprise a conductive, uncoated projection protruding from coatedjaws.

In FIGS. 19 c and 19 d , an alternative embodiment of a non-CDTD systemis illustrated comprising inner beads 1951 i and outer beads 19510coupled with a bow/support member 1970 and further comprising an energywindow made up of a plurality of electrode termini 1906 for deliveringenergy such as RF. This embodiment is similar to that depicted in FIG.15 a-k . In some embodiments the RF energy delivered by the termini 1906may be distinct from the RF energy delivered by the lysing segmentsbetween the adjacent beads. More particularly, in the depictedembodiment, the energy window comprises an energy window strip 1907which is preferably made of a conductive material. Energy window strip1907 comprises a plurality of energy window termini 1906 protruding fromthe energy window strip 1907. An insulation cover 1908 may be configuredto be coupled with energy window strip 1907. In some embodimentsinsulation cover 1908 may be molded onto energy window strip 1907.Alternatively the insulation cover 1908 may be configured to receive theenergy window strip 1907 or otherwise be coupled with energy windowstrip 1907. Preferably, the insulation cover 1908 comprises anon-conductive material. In the depicted embodiments, the insulationcover 1908 comprises an elongated base configured to cover the energywindow strip but allow the energy window termini 1906 to protrudethrough the insulation cover 1908. In addition, the insulation cover1908 comprises a plurality of protruding bead coupling members (notshown here, but as depicted in FIG. 15 h , bead coupling member 1508′),each of which is configured to extend into and be coupled with one ofthe beads of the tip via hole 1955 o (as shown in FIG. 15 i , across-sectional view down/through the center of outer bead 1551 d).Energy delivery conduit 1909 such as a wire may be coupled with theenergy window strip 1907. Preferably, the energy delivery conduit 1909is insulated from the energy delivery conduit that delivers energy tothe lysing segments such that a distinct type of energy may be deliveredtherethrough.

In other embodiments, the energy windows may be configured to utilizeenergy of different modalities, including, but not limited to, laser,intense pulse light, resistive heating, radiant heat, thermochromic,ultrasound, mechanical, and/or microwave.

In alternative embodiments, the energy window strip 1907 may beconfigured to be positioned on the bottom of the device, thus mounted onthe bottom of beads 1951 i/1951 o. However, in various implementations,a surgeon may simply invert the tip of a top-mounted energy strip 1907so that it points in the opposite direction (for example, away from thesurface skin and toward the subcutaneous tissues. Thisinward/subcutaneous direction of energy may be useful in directingenergy toward the subcutaneous deposits in cellulite and other cosmeticconditions.

FIGS. 20 a-20 o depict another embodiment of a CDTD or non-CDTD system2000. System 2000 comprises protrusions 2001 and recessions 2002. System2000 comprises a lysing tip 2010 that is configured to be completelyseparable from any other element of the system, however, lysing tip 2010is configured to work in conjunction with the substantiallyellipsoidal-shape at the distal end of jaws 2093 a/2093 b ofgrasping/control instrument 2090, as this preferably insulated shape mayserve the same functions as beads 2051 a/2051 b as previously discussed.Lysing tip 2010 comprises two beads 2051 a/2051 b positioned at oppositeend of lysing member 2060. In the depicted embodiment, lysing member2060 comprises plate 2060 which may comprise grasping pad 2071. Uponbeing grasped by grasping/control instrument 2090 to perform a surgicalprocedure, the distal tip 2093 of grasping/control instrument 2090substantially mimics the shape and/or function of beads 2051 a/2051 bsuch that two lysing segments are defined on opposite ends between tip2093 and bead 2051 a on one side and between tip 2093 and bead 2051 b onthe other. In some embodiments, the portion of distal tip 2093 extendingonto or beyond lysing plate 2060 may have an identical or at leastsimilar distal shape and size to beads 2051 a/2051 b. For example, thisportion of distal tip 2093 may have rounded/smooth surfaces that tapertowards a rounded tip similar to beads. At the very least, it ispreferred that distal tip 2093 be shaped and sized such that lysingplate 2060 can come in contact with or near contact with target tissues.Together, the beads 2051 a/2051 b and distal tip 2093 may function asblunt dissectors to separate tissues without cutting. While the deviceis energized with electrosurgical energy, beads 2051 a/2051 b and outersurface distal tip 2093 are preferably non-conductive in order toperform the blunt dissection function. The inside of jaws 2093 a and/orits corresponding lower jaw 2093 b define a receiving slot 2097 and oneor both may be electrically conductive in order to permitelectrosurgical energy to flow to the lysing plate 2060.

System 2000 is configured to prevent or limit lateral movement of outerbeads 2051 by fixing bead holes 2053 a/2053 b in outer beads 2051 a/2051b and corresponding lysing plate holes 2066 a/2066 b through which aresulting substantially solid object like a pin or glue may be insertedto effectively couple the beads 2051 to the lysing plate 2060. Inalternative embodiments, lysing plate holes 2066 a/2066 b may bereplaced with grooves that may receive the solid object(s) insertedthrough fixing bead holes 2053.

In alternative embodiments, the dimensions of plate 2060 may be reducedto approach the width and/or thickness of previously described lysingrods. In such embodiments, the corresponding tunnel in outer beads 2051a′/b′ may be appropriately reduced to match corresponding dimensionsand/or the corresponding grooves and in one or more of the jaws 2093a′/2093 b′ of the grasping instrument may similarly be modified to matchthat of at least a portion of rod 2060′. In alternative embodiments asshown in FIG. 20 o , upper jaw 2093 a″ may consist of a front portionthat overhangs truncated lower jaw 2093 b″, thus reducing thepossibility of tissue entry on forward motion. In other embodiments, theoverhang may encompass a larger portion of the opposite jaw. In thisdepicted embodiment, jaws 2093 a″/2093 b″ are configured such thatdespite the previously described overhang of upper jaw 2093 a″, when thejaws are in a closed configuration, the distal portion of the instrument2090′ substantially mimics the shape about the distal portions of thebeads about the distal portion of the instrument 2090′.

In some embodiments, lysing member 2060′ comprises a rigid and/orsubstantially rigid wire as shown in FIGS. 20 i-20 o . In suchembodiments, one or both of jaws 2093 a″ and 2093 b″ may comprise a slotconfigured to receive the rigid wire/lysing rod 2060′. This slot 2097′may be configured so as to tightly receive lysing rod 2060′ so as toprevent or at least inhibit rotation of lysing tip 2010′. Alternatively,slot 2097′ may either be slightly larger than the diameter of lysing rod2060′ or may be configured to allow a user to adjust the size of slot2097′ by actuating one or both of jaws 2093 a′/2093 b′ such that theuser can provide for a desired amount of rotation corresponding with theforce delivered to jaws 2093 a′/2093 b′. As previously mentioned, otherfeatures may be included to limit or selectively allow for rotation suchas welds and/or spacers (for example, spacer 2062′ extending from insideeach outer bead or spacer 2062″ coupled to lysing rod 2060′ extendingfrom side of outer bead to side of grasping jaw 2093 a″/b″). Forexample, in some embodiments, spacers may be positioned adjacent toopposing outer beads 2051 a′/b′ such that jaw 2093 a′/b′ may grip lysingrod 2070′ in between the two spacers. Such spacers may be used to eitherinhibit or selectively limit rotation by, for example, their shape,and/or proximity to jaws 2093 a′/b′. In this embodiment, a surgeon maybe able to dissect on one or more of the sides on the backstroke,possibly making surgery more efficient. In some preferred embodimentsand implementations, allowing for reverse dissection, it may bepreferable to either loosen the grip of the lysing rod or otherwiseprovide for a coupling between the jaws that is loose enough allow forrotation the lysing rod within the jaws. Alternatively, a rigid couplingbetween the lysing rod and the jaws may be provided and instead thebeads may be configured to rotate about the lysing rod such that thedistal ends of the beads become the proximal ends when the lysing tip isbeing reversed.

In alternative embodiments, lysing rod 2060′ may not be end capped atthe exact outermost portions of its tips. Instead any number of holes2055′ may be made at any number of angles to intersect the lysing rod2060′ and/or its tunnel 2054 or 2054′ to deposit a material thatrestrains the lysing rod within the bead 2051 a′/b′ (for example,materials may include welds, glues, epoxies, plugs (2055 p), and thelike). In such embodiments, tunnel 2054′ may be a blind tunnel notrequiring full passage through bead 2051 a′/b′ as bead may befixed/restrained internally. See for example FIGS. 20 j/k showing sideviews of beads 2051 a′ and 2051 a″. FIG. 20 k shows full passage oftunnel 2054 which intersects with hole 2055′ (illustrated with dashedlines designating hole 2055′ being internal to bead 2051 a′). FIG. 20 jillustrates tunnel 2054′ (illustrated with dashed lines) whichintersects with hole 2055′ (illustrated with dashed lines designatinghole 2055′ being internal to bead 2051 a″) not extending to the outsideof outer bead 2051 a″. This alternative embodiment may be applied toother embodiments herein. In alternative embodiments, beads 2051 a′/b′may be replaced with beads of any shape, including but not limited tothose depicted in FIGS. 12 aa to 12 rr. In some embodiments wherein aspacer is positioned between a lysing rod and grasper jaws, thetolerance between the lysing rod and a spacer may allow for rotation ofthe lysing rod within the spacer and thus allow for rotation of beadswith respect to a spacer and/or grasper. The tolerance may be adjustedto allow for a predetermined amount of rotation.

In the embodiment illustrated in FIGS. 21 a-e , the lysing tip 2110comprises grasping plate 2161, lysing rod 2160, and beads 2151 a/2151 b.In this embodiment the inner surfaces of upper jaw 2193 a and lower jaw2193 b (of grasping/control instrument 2190) are configured to match orsubstantially match the upper and lower surfaces of grasping plate 2161in the closed configuration (thus creating receiving slot 2197). Thelysing rod 2160 may be permanently or temporarily coupled to graspingplate 2161 for example by weld, and/or by snap-fit between the distalend of the grasping plate 2161 and the center/proximal portion of lysingrod 2160. In the depicted embodiment, the width of the grasping platetapers from a widened portion of the proximal end to a narrowed portionof the distal end which tapering may mimic or substantially mimicsimilar tapering of the corresponding jaw 2193 a/2193 b. The length ofgrasping plate 2161 may be similar to or identical to the length of oneor both jaws 2193 a/2193 b. In some embodiments, the outer surfaces ofjaws 2193 a/2193 b may be surface-coated with a non-conductivedielectric coating.

Lysing tip 2110 may comprise a plurality of protrusions 2101 comprisingdistal portions of beads 2151 and recessions 2102 between each beadpair. The portions of lysing member 2160 extending between adjacentbeads 2151 a/2151 b may be considered the lysing segment.

As previously mentioned, beads 2151 may be coupled with one another byway of a single lysing member 2160 extending through tunnels 2154extending through each of the respective beads 2151. In the depictedembodiment, beads 2151 each comprise a non-symmetrical shape and/or maybe eccentric relative to tunnels 2154. More particularly, tunnels 2154are positioned distally of a central portion of beads 2151 such thatthere is more material proximally of tunnels 2154 than distally. Beads2151 a and 2151 b have a similar distal or frontal shape (from theperspective of the treatment side of tip 2110) but have a flattened,thus shorter (from the elongated-axis perspective), rear end 2153 a. Inother embodiments, beads may have a greater elongated-axis dimension.

As previously mentioned, this may be preferable for some embodiments,particularly embodiments in which beads 2151 can at least partiallyrotate on the lysing rod or other lysing member 2160 to allow the lysingtip 2110 to be directed through tissue in a desired manner. In somecontemplated embodiments, beads may be symmetrical.

Preferably, the entire surfaces of the beads 2151, or at least outerbeads 2151 a and 2151 b, may be smooth or at least substantially smooth.Or, at least all surfaces that may be expected to contact tissue duringa surgical procedure may be substantially smooth. For example, providinga smooth front end and a smooth trailing end may allow the lysing tip tobe moved in a forward direction and then in a rearward direction backand forth without catching an undesirable amount of tissue on beads toinhibit such movement. As shown, in some embodiments, the trailing endof some beads, such as beads 2151 a and 2151 b, may comprise a flatsurface such that each bead comprises a frusto shape or another similarshape. Preferably, at least the forward or distal surface of each beadis substantially smooth and defines an ellipsoidal shape or anothershape having a substantially smooth forward surface. In the depictedembodiment, beads surfaces may have facets 2152.

In other contemplated embodiments, providing a rough trailing end maycreate frictional drag on that portion of the bead thus helping reorientthe front end of the bead for further tissue passage. Thus, in someembodiments, the trailing end may have a rougher surface than the frontend

As previously mentioned, in some embodiments, it may be desirable toallow beads 2151 to rotate, at least partially, on lysing member 2160.Thus, beads 2151 may not be fixed three-dimensionally with respect tolysing member 2160 and/or one or more other elements of lysing tip 2110.In some such embodiments, beads 2151 may be at least partially rotatablewith respect to the remainder of lysing tip 2110. In embodiments inwhich beads 2151 are rotatable in this manner, it may be desirable touse a lysing member having a circular cross section.

Preferably, lysing member 2160 terminates within outer beads 2151 a and2151 b. Thus, it may be desirable to melt, tip, ball, crimp, fold, tie,or otherwise couple the ends of lysing member 2160 within outer beads2151 a and 2151 b at opposing lysing member coupling tips 2163 a and2163 b. Preferably, lysing tip 2110 is configured such that each ofbeads 2151 is rotatable independent of one another.

Coupling tip 2163 a/b may be configured to engage a ledge positioned ata transition point between two concentric tunnels (2159 a/2159 b)(similar to that depicted in FIG. 17 c at tunnels 1759 a/1759 b). Moreparticularly, outer tunnel 2159 b may comprise a larger diameter orother cross-sectional dimension than inner tunnel 2159 a such thatlysing member 2160 may extend through inner tunnel 2159 a but couplingtip 2163 a due to its larger size may be configured to extend throughouter tunnel 2159 b without passing through inner tunnel 2159 a. Inother embodiments, there may be a single tunnel that tapers (similar totunnel 1759 c in FIG. 17 c ) from a larger dimension on the outer sideof bead 2151 to a smaller dimension toward the inside of the beadrelative to the lysing tip 2110.

In some embodiments, at least a portion of grasping plate 2161 maycomprise a conductive material and may be configured to receiveelectrosurgical energy, such as from a grasping/control instrument 2190or another surgical tool or external wire, and deliver such energy tolysing member 2160. For example, in some such embodiments,electrosurgical energy may be delivered through grasping jaws 2193a/2193 b, into grasping plate 2161 and into lysing member 2160. In otherembodiments, grasping plate 2161 may be insulated and electrosurgicalenergy may instead be delivered to lysing tip 2110 in another manner.For example, upper jaw 2193 a may be insulated but comprise one or morenon-insulated projections 2196 a and 2196 b that may correspond to oneor more non-insulated openings 2173 a and 2173 b respectively ingrasping plate 2161 (that is otherwise substantially insulated).Although a single projection/opening may be used in some embodiments, itmay be preferable to have two such projections/openings as depicted inFIGS. 21 b and 21 c . Providing two or more projections/openings mayimprove stability of the lysing tip during treatment. One or both of theprojections/openings may be configured to deliver electrosurgical energyfrom instrument 2190 to lysing tip 2110. This configuration withmultiple projection/opening pairs may be used in similar embodimentsdisclosed herein.

In embodiments comprising a free-floating lysing tip, including theembodiments of FIGS. 17-31 and 35-38 , certain preferred embodiments mayhave a size/length TL (as illustrated in FIGS. 10 d /10 e) of about 15mm from the end of one protrusion and/or bead to the oppositeprotrusion/bead on the opposite end; the height BH (as illustrated inFIGS. 10 d /10 e) of the largest outer beads may range from 2 mm to 10mm. In some embodiments, this dimension may be defined by the distancefrom the upper end of one or more (in some embodiments, each) beads tothe lower end of one or more beads. In some free-floating embodiments,the lysing tip may have a size/width TW (as illustrated in FIGS. 10 d/10 e) of about 4.5 mm from the distal end of the beads to the proximalend of the lysing tip. However, it should be understood that a widevariety of alternative shapes and/or sizes may be usable depending uponthe particular surgical procedure involved.

FIGS. 22 a-e illustrate system 2200 comprises lysing tip 2210 andgrasping/delivery instrument 2290, this embodiment only differing fromsystem 2100 in that beads 2251 a/2251 b are rounded on the outerproximal corners 2253 a/2253 b relative to the axis of thegrasping/control instrument 2290. Rounding the outer proximal cornersmay further inhibit lysing tip 2210 from catching tissue rather thancutting or bluntly separating said tissue. Lysing tip 2210 comprisesgrasping plate 2261, lysing rod 2260, and 2 beads 2251 a/2251 b throughwhich lysing rod 2260 extends (through tunnels in beads 2251 similar totunnels through beads 2151 a/2151 b in FIG. 21 a-21 e ). Each of beads2251 may be coupled to lysing rod 2260 by coupling tips 2263 a/2263 band as otherwise set forth herein. Upper and lower jaws 2293 a/2293 b(that, when closed, define receiving slot 2297) respectively may graspgrasping plate 2261. Lysing tip 2210 is configured to be completelyseparable from the grasping/control instrument 2290 of the system.Lysing tip 2210 may comprise a plurality of protrusions 2201 comprisingbeads 2251 a/2251 b and recessions 2202 between the bead pairs.

FIGS. 23 a-d illustrate system 2300 comprising lysing tip 2310 andgrasping/control instrument 2390, this embodiment only differing fromsystems 2100 and 2200 in that beads 2351 have an ellipsoidal shape alongthe entire length of the beads and comprise holes 2355 which may beconfigured for receipt of a cord that may be a suture, hook, or similardevice that may grasp and hold lysing tip 2301. This may be used as asafety feature for ensuring that a surgeon has the ability to retrievelysing tip 2301 in the event that it becomes uncoupled from instrument2390. This additional length as compared to the shapes of the beads inembodiments in FIGS. 21 a-e and 22 a-e may assist in maintaining theoptimal positioning for beads 2351 to migrate through and/or separateand/or cut tissue. Lysing tip 2310 comprises grasping plate 2361, lysingrod 2360, and 2 beads 2351 through which lysing rod 2360 extends(through tunnels in beads 2351 similar to tunnels through beads 2151a/2151 b in FIG. 21 a-21 e ). Each of beads 2351 may be coupled tolysing rod 2360 by coupling tips 2363 and as otherwise set forth herein.Upper and lower jaws 2393 a/2393 b respectively may grasp grasping plate2361. Lysing tip 2310 is configured to be completely separable from thegrasping/control instrument 2390 of the system. Lysing tip 2310 maycomprise a plurality of protrusions 2301 comprising beads 2351 andrecessions 2302 between the bead pair.

Given the extra length of the beads 2351 in this embodiment, material isavailable for holes 2355. Hole(s) 2355 may, together with a cord 2344,for example, comprise an example of means for detachably maintainingretrievability of a lysing tip. In preferred embodiments and/orimplementations, suture 2344 or another loopable element may be loopedthrough one or more such hole(s) and then may extend through one or morecannulas used to deliver lysing tip 2310 proximally back to a surgeon.In this manner, in the event of a failure to grasp or otherwise couplelysing tip 2310 to a grasping/control instrument, such asgrasping/control instrument 2390, lysing tip 2310 may be retrieved fromwithin a patient's body by pulling on suture 2344 to retract lysing tip2310 though a cannula. In some embodiments, hole 2355 may also oralternatively be used to maintain position of lysing tip 2310 whileawaiting delivery of a grasping/control instrument 2390 for performingsurgical procedures. Upon properly coupling lysing tip 2310 with anappropriate tool for grasping and/or controlling lysing tip 2310, suchas grasping/control instrument 2390, a surgeon may cut suture 2344,preferably near a knot or other feature used to form a loop around hole2355. If a suture 2344 or other similar material/element is used that issufficiently flexible and non-disruptive, this shorter loop may beconfigured to be present during a surgical procedure using lysing tip2310 without unduly interfering with the procedure. In alternativeembodiments, holes 2355 may be available as a platform/location to addother features/components such as providing a location for a placementof one or more sensors and/or RFID location component(s) and/or beingused for placement of luminescent and/or light production element(s) forvisualization, for example, tritium and the like.

In alternative embodiments, hole 2355 may be moved to fully or partiallyintersect tunnel 2354 thus allowing communication with lysing rod 2360;thus a weld, plug, glue, insert or other method of fixation may beinserted via hole 2355 to attach to lysing rod 2360 thus restrictinglateral movement of a bead. To reduce escape of electrosurgical energythrough hole 2355, an insulator comprised of epoxy, plastic, ceramic orthe like may be placed in part or all of the remaining hole 2355. Thisalternative embodiment may be applied to other embodiments herein.

Another embodiment is depicted in FIGS. 24 a and 24 b . System 2400comprises modular lysing tip 2410 comprising recessions 2402 created byadjacent protrusions 2401. Lysing tip 2410 further comprises a supportmember 2470 defining a bow shape 2470 that may be coupled physically andelectrically to a shaft 2499 a extending proximally from bow 2470. Shaft2499 a may be conductive and/or may reversibly couple with conductiveslot 2479 s formed in an electrosurgical instrument 2479 which may be anelectrosurgical pencil (such as a ‘Bovie’ and/or other electrosurgicalpencil and/or other electrosurgical adaptive device(s)) capable ofreceiving shaft 2499 a, through which electrosurgical energy may bedirected and controlled to lysing tip 2410. Lead 2479L may be coupledwith an electrosurgical generator. Beads 2451 a/2451 b/2451 c/2451 d maycomprise facets 2452 and may be coupled to support member 2470 by lysingrod (not shown in FIGS. 24 a /24 b) which is covered by spacers 2462a/2462 b/2462 c. Coupling tips 2463, as stated earlier herein, couplethe lysing rod in place within outer beads 2451 a/2451 d. Insulation2499 b may cover or substantially cover shaft 2499 a to facilitatehandling by personnel and may be extended to cover all or portions ofbow 2470 preventing electrosurgical energy from being distributed totissue from the bow 2470. This embodiment may have uses in opensurgeries and/or non-CDTD procedures.

An alternative embodiment is depicted in FIG. 24 c . System 2400′comprises modular lysing tip 2410′ (which is comprised of outer beads2451 a′/2451 d′, and lysing rod 2460′), shaft 2499 a′ and insulatedcovering 2499 b′ that terminates distally with bulbousprojection/protrusion 2499 t. One or more of the exposed segments oflysing rod 2460′ may be covered by spacers 2462′. Lysing rod 2460′ maybe electrically coupled to a shaft 2499 a′ extending proximally fromlysing rod 2460′. Shaft 2499 a′ may be conductive and/or may reversiblycouple with an electrosurgical instrument 2479 which may be anelectrosurgical pencil (such as a ‘Bovie’ and/or other electrosurgicalpencil and/or other electrosurgical adaptive device(s)) capable ofreceiving shaft 2499 a′ within a conductive slot 2479 s through whichelectrosurgical energy may be directed and controlled to lysing tip2410′. Insulated covering 2499 b′ may cover or substantially cover shaft2499 a′ to facilitate handling by personnel and may be extended distallyin the shape of or to substantially mimic the shape of the distalportion of a bead 2451 a′/2451 d′, thus serving as a 3^(rd)projection/bead. More particularly, this bulbous protrusion 2499 t mayextend distally as far as the tips of beads 2451 a′/2451 d′. Thisembodiment may have uses in open surgeries and/or non-CDTD procedures.

The CDTD and/or non-CDTD systems and/or apparatus (hereafter “TD”)disclosed herein may be used to treat the following disclosed below.

In a general implementation of a method using one or more of the devicesdescribed herein, a tip deployment pocket may be created at or near theentrance incision, for example, in skin or muscle. Alternatively, someimplementations may not require a tip deployment pocket. The lysing tipof the TD may be inserted through the entrance incision and in someimplementations into the tip deployment pocket while in otherimplementations directly into a body cavity. The lysing tip may then bereconfigured from a delivery configuration to a treatment configurationsuch as by rotating the lysing tip and/or coupling the lysing tip to agrasping/control instrument. The lysing tip may then be activated. Adissection path may then be made to one or more target tissues. Thelysing tip may then be used to dissect around or through target tissuesand/or used to treat the target tissue. In some implementations, the oneor more target tissues and/or surrounding tissues may then be treated toachieve hemostasis with the lysing tip or the tissue modification tip(TMT). The lysing tip may then be rotated back to a deliveryconfiguration to allow the lysing tip to be withdrawn. In someimplementations, the lysing tip may delivered and/or withdrawn using oneor more cannulas. In other implementations, the lysing tip may deliveredand/or withdrawn without a cannula.

In FIGS. 25 a-e , system 2500 a tether 2544 extends through an opening2593 h formed in a jaw 2593 of the grasping/control instrument 2591.Tether 2544 may further be configured to be coupled with free-floatinglysing tip 2510 that may be comprised of support member/bow 2570,grasping pad 2571 located on support member/bow 2570, beads 2551,spacers 2561, and rod (not shown). In the depicted embodiment, tether2544 couples with grasping pad 2571. More particularly, grasping pad2571 comprises an opening 2571 h configured to receive the tether 2544as shown in the cross-sectional view of FIG. 25 d . In some embodiments,the opening 2571 h may comprise a blind opening in which case tether2544 may comprise a distal bulb 2544 c and/or stop that prevents tether2544 from pulling through the opening 2571 h. Alternatively, opening2571 h may comprise a through-hole which may allow tether 2544 to extendall the way through opening 2571 h on both ends of the opening.

In the depicted embodiment, by pulling on tether 2544 either manually orby way of a mechanism, tip 2510 may be configured to be directed intothe jaws 2593/2594 of grasping/control instrument 2591. In still otherembodiments, tether 2544 may be coupled with tip 2510 without alsoextending through one or both of jaws 2593/2594. In this manner the tip2510 may be retrieved simply by pulling on the tether 2544. In otherembodiments, a tether 2544 may extend through other portions of thegrasping instrument, such as the bottom jaw 2594 and/or both jaws2593/2594 and/or through the center of the grasping/control instrument2591.

In some embodiments, one or more magnets may be used to guide lysing tip2510 towards and/or lock lysing tip 2510 in a desired location such aswithin jaws 2593/2594 of the grasping control instrument 2591. Forexample, one or more magnets may be positioned along grasping pad 2571(magnet 2592 p) and/or within one or both of jaws 2593/2594 (magnet 2592j) of system 2500. If a magnet is positioned within one or both jaws2593/2594, grasping pad 2571 may comprise a magnetic portion and/orelement configured to engage such magnet(s). Similarly, if a magnet ispositioned on grasping pad 2571, a magnetic portion and/or element maybe positioned within one or both jaws. Alternatively, magnets may bepositioned on both the grasping pad and one or both of the jaws.

The tether may be packaged with a tether already attached or medicalpersonnel at the procedure may choose an appropriate tether to threadand catch in the lysing tip and thread through the jaw with thethrough-hole.

The surgeon may attach the cord/suture to hole 2571 leaving a tail ofstitch that may be up to 50 cm long. The grasping instrument 2591containing hole 2593 h may be inserted into the body percutaneously andexit through an larger trocar for example located in the umbilicus. Thetail of the suture/cord may then be pulled back out the originalpercutaneous incision and fed through hole 2593 h. The graspinginstrument containing hole 2593 h may then be reinserted percutaneouslyand the lysing tip 2510 fed down the second (for example, umbilicaltrocar) percutaneous body cavity entry/wound. The cord/suture tail isthen pulled by the surgeon to seat the frame within the grasper.

Yet another embodiment of a lysing tip 2610 comprising beads 2651 a/2651b/2651 c/2651 d is depicted in FIGS. 26 a and 26 b . Lysing tip 2610comprises a support member 2670 which may be in the approximate shape ofa bow as previously discussed. However, the distal end of lysing tip2610 is bowed in the opposite direction such that middle beads 2651b/2651 c protrude distally to a greater degree than outer beads 2651a/2651 d. In addition, lysing rod 2660 rather than being straight as inprevious embodiments collectively curves and/or bows distally. In someembodiments, however, each of the various segments 2662 a/2662 b/2662 cbetween adjacent beads may be straight or be substantially straight. Asalso previously discussed, support member 2670 may comprise an opening2673 which may be configured to receive a tooth or other projection of agrasping/control instrument (not shown in this figure, but depicted inother embodiments). In FIG. 26 a , support member 2670 may furthercomprise a tongue 2676 that protrudes distally to couple with the centersegment of lysing rod 2660. More particularly, in the depictedembodiment, tongue 2676 comprises a groove defined on either side byedges 2676′ configured to receive center segment of lysing rod 2660 soas to deliver electrosurgical energy from an instrument into lysing rod2660. As previously discussed, each of the various segments of lysingrod 2660 is preferably electrically coupled through adjacent beads toits adjacent lysing member. As shown in FIG. 26 a , spacers may beprovided between outer beads and but not the adjacent middle beads. Thismay be because tongue 2676 a/2676 a′ may serve as a suitable spacer.However, as shown in FIG. 26 b , in some embodiments, center spacer 2662b may be provided on the center segment of lysing rod 2660 if needed ordesired.

FIGS. 27-30 comprise various embodiments of free-floating lysing tipsthat may be used with the various surgical tools set forth, for example,in FIGS. 17 a-m . However, alternative embodiments are contemplated inwhich these free-floating lysing tips may instead be modified so as tobe coupleable with actuation rods and/or one or more cannulas as setforth herein such that the free-floating lysing tips becomenon-free-floating lysing tips. as shown, for example, in FIGS. 14 a -n.

In FIGS. 27 a-j , lysing tip 2710 is “free-floating” (can be uncoupledfrom any control instrument or cannula) and comprises a plurality ofsleeves 2780/2781 positioned on lysing rod 2760 which may correspond innumber to the number of beads 2751 a/b/c/d. Beads 2751 a/b/c/d may bemolded onto or otherwise positioned onto one or more sleeveconfigurations, for example, outer bead sleeve configuration 2780 a/2780b and middle bead sleeve configuration 2781 a/2781 b. Preferably sleeves2780/2781 are made of a material configured to insulate the materialmaking up the beads from the heat generated by the lysing rod 2760during a surgical procedure. Sleeves 2780/2781 may also or alternativelyserve as hubs permitting rotation of beads around the axis of lysing rod2760. For example, the beads may rotate about the rod upon encounteringtissue similar to that of a vegetable/fruit peeler.

Middle bead sleeve 2781 may comprise a raised band 2784 which is formedat a central or substantially central location around both middle-beadsleeves 2781 a/2781 b which may serve to prevent lateral movement ofmiddle beads 2751 b and/or 2751 c off of middle-bead sleeves 2781 a/2781b. Bead band channel 2753 may be configured to accept raised band 2784.Likewise, outer bead sleeves 2780 a/2780 b comprise an external ledge2786 a and internal ledge 2786 b that transitions between a largerdiameter portion 2782 and a smaller diameter portion 2783 of an innertunnel of the outer bead sleeves. The larger diameter portion 2782 isalternatively referred to herein as a raised band. In some preferredembodiments comprising bead sleeves, the beads may comprise a molded ormoldable material, such as a moldable, biocompatible plastic, gelatin(for example, protein, polysaccharides and/or derivatives thereof), orhydrogel, for example. In some such embodiments, the beads may beovermolded onto each of their respective sleeves.

External sleeve ledge 2786 a may be configured to engage a correspondinginternal bead ledge 2759 within outer beads 2750 a/2750 b. Similarly,outer bead sleeves 2780 a/2780 b may comprise two concentric holes withledge 2786 b approximately half-way between the opposite openings.Internal bead ledge 2786 b may be configured to engage coupling tips2763. This configuration creates a feature that may prevent lateralmovement of outer beads 2751 a/2751 d off of outer bead sleeves 2781a/2781 b. In other embodiments, coupling tip 2763 may engage a singletunnel that tapers (similar to tunnel 1759 c in FIG. 17 c ) from alarger dimension on the outer side of bead to a smaller dimension towardthe inside of the bead as depicted in FIG. 27 j . In some embodiments,it may be desirable to provide features and/or elements that inhibit orlimit the ability of the electrosurgical energy to discharge from theopposing ends of the lysing rod 2760 at coupling tips 2763. Thus, insome such embodiments, coupling tips 2763 may be coated or covered witha suitable insulating material such as an epoxy with non-conductiveproperties. Alternatively, outer bead hole 2754 at the end with thelarger-opening may be capped or plugged with an element configured to bereceived or otherwise engage the larger opening of the bead. Preferably,this element will have non-conductive properties similar to theinsulating material previously referenced.

As depicted in FIG. 27 c , lysing tip 2710 may comprise protuberances2765 c/2765 d positioned on/coupled to lysing rod 2760, one protuberance2765 c/d may be positioned on each side of each middle bead 2751 c asshown in FIG. 27 c . Protuberances 2765 c/d may serve to prevent orlimit lateral movement of middle beads 2751 b/2751 c on the lysing rod2760 and/or may, depending upon a protuberance pair's distance from abead, serve to limit or prevent rotation of beads around the axis oflysing rod 2760. In alternative embodiments, one or more spacers 2762(and such as those in FIGS. 9 a-9 e , spacers 962) may be used in placeof protuberances 2765 c/d. In the depicted embodiment, spacer 2762 inFIG. 27 c is pentagonal in cross-section; in other embodiments,alternative spacers with unique cross-sectional configurations, such asfor example those set forth in FIGS. 12 h-t , may be used. Inalternative embodiments, lysing rod 2760 may be deformed prior tocoupling with a middle bead sleeve such that the outer diameter of 2760may couple via friction fit with the inner tunnel surface of middle beadsleeve 2781. FIGS. 27 b and 27 c purposefully have components removed toexpose inner components and also illustrate different means to holdmiddle beads in an intended position via protuberances and/or spacers.Alternatively, middle bead sleeves 2781 may be more loosely coupled withlysing rod 2760 so as to allow for rotation of middle bead sleeve 2781thereon, and thereby allow for at least some rotation of theircorresponding beads on lysing rod 2760. In alternative embodiments,lysing tip 2710 may be configured without a solid lysing rod and/orwithout spacers and/or welds and the like. In such embodiments, internalbead tunnels 2754 and support member holes 2767 a/2767 b may beconfigured to accommodate a hollow lysing rod similar to that depictedin FIG. 17 k . Between beads, the hollow lysing rod may be deformed in amanner to prevent lateral movement of beads and/or prevent rotation ofbeads. The hollow lysing rod may be deformed minimally or to a pointthat it is substantially flat. In such embodiments, it may be preferablefor the front edge to point distally as the leading front edge. In suchembodiments, screws may secure one or both ends of the hollow lysing rodwithin outer beads 2751 a/2751 d. The configurations of this alternativeembodiment may be available for any other similar embodimentcontemplated herein.

In this configuration, adjacent protrusions 2701 create recessions 2702in which recessed lysing rod 2760 may deliver electrosurgical energyduring a surgical procedure.

FIG. 27 e illustrates a perspective view of outer bead 2751 a coupled toouter bead sleeve 2780 a with coupling tip 2763 being recessed withinouter bead sleeve 2780 a. Lysing rod 2760 is illustrated in FIG. 27 dbeing received within outer bead sleeve 2780 a. FIG. 27 d illustrateshow lysing rod, sleeve and bead may be assembled: Outer bead sleeve 2780a may be extended into outer bead 2751 a stopping at the point thatexternal sleeve ledge 2786 a reaches the internal bead ledge 2759 whichmay be followed by extension of lysing rod 2760 through outer beadsleeve 2780 a stopping at the point coupling tip 2763 reaches theinternal sleeve ledge 2786 b created by the larger-diameter bead sleevehole 2786 h and smaller-diameter sleeve hole 2787 a. In alternativeembodiments, as depicted in FIG. 27 j , the sleeve 2780′ may beconfigured to have a single cone-shaped tunnel 2786′ that tapers(similar to tunnel 1759 c in FIG. 17 c ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the beadin order to engage coupling tip 2763.

Outer beads 2751 a/d may comprise hole 2755 through which a cord may behooked and/or tied in order to facilitate deployment or retrieval asearlier stated herein regarding hole 1755 in FIG. 17 d.

Support member 2770 may be preferably insulated, except for regions onwhich it is desired to transfer electrosurgical energy such as (1) atone or more surfaces of grasping pad 2771, (2) within the 2 distalsupport member holes (as shown in FIG. 17 e, 1767 a /1767 b), and/or (3)the opposing distal ends of support member 2770, in some cases distal oflysing rod 2760 in order to deliver electrosurgical energy not onlythrough lysing rod 2760 but also through these distal ends of supportmember 2770.

Support member 2770 in the current embodiment comprises a bow shapecomprising two opposing end tips comprising holes or other openingsthrough which lysing rod 2760 extends. The two tips of support member2770 may extend far enough distally to provide sufficient material toform the lysing rod through-holes. Alternatively, openings comprisingslots or the like may be formed at one or both of the two opposing tipsof support member 2770 if desired.

The two tips of support member 2770 preferably do not extend beyond thedistal tip of any bead and preferably remain as proximal to lysing rod2760 as possible. The ends/tips of support member 2770 may or may not beelectrically insulated. If insulated, said tips will act more like beads2751 a/b/c/d to physically separate tissues or tissue planes; however,if not insulated, said tips may perform like lysing rod 2760 deliveringelectrosurgical energy to lyse tissue.

FIGS. 27 h-i illustrates middle bead 2751 b comprised of facets 2752 (2of a total of 4 on this bead are identified in the illustration),coupled to middle bead sleeve 2781 through which lysing rod 2760extends. Middle bead 2751 b may differ from outer bead in that itslength may be shorter and its rear wall 2758 may be flat orsubstantially flat. The length of middle bead 2751 b may be such thatthe rear portion of middle bead 2751 b/c may not contact support member2770 in its relaxed state and/or when the bead's distal tip is pointingin the same direction as lysing tip 2710, however, middle bead 2751 bmay contact support member 2770 if lysing rod 2760 is pushed back orotherwise deformed during a surgical procedure and/or the middle bead2751 b/c is rotated about the lysing rod 2760 such that the top orbottom of the rear portion of the bead may contact support member 2770.For example, the spacing between middle beads 2751 b/c and supportmember 2770 may be used to selectively limit the amount with whichmiddle beads 2751 b/c may rotate. Similarly, in some embodiments, thisspacing may be configured to serve as a backstop to allow for apredetermined amount of proximal movement of middle beads 2751 b/cduring a procedure.

In FIGS. 28 a -L, outer beads 2851 a/2851 d define an annular shape. toMore particularly, outer beads 2851 a/2851 d comprise annular beadstructure 2857. In addition, these beads may be elongated or oval incross section. Middle beads 2851 b/2851 c on the other hand have similardefined protrusions on their distal ends, however, proximal ends ofthese beads terminate in opposing knobs 2855 rather than defining a fullannular shape. In both middle and outer beads, a bead hub 2856 ispositioned within annular bead structure 2857 to allow for coupling ofbeads 2851 with their corresponding sleeves. Bead hub 2856 is coupled toannular bead structure 2857 by way of one or more spokes 2858 and/or abead hub frame 2856 a. In the depicted embodiment, bead hub frame 2856 aextends about a central portion of bead hub 2856 from bead hub 2856 toannular bead structure 2857. Bead hub frame 2856 a is only coupled to aportion of annular bead structure, and a portion of bead hub 2856.However, alternative configurations are possible in which bead hub frame2856 a may be coupled to the entire annular bead structure 2857 and/orthe full periphery of bead hub frame 2856 a. A single spoke 2858 mayextends from bead hub 2856 in a direction perpendicular to bead hubframe 2856 a. As best depicted in FIG. 28 k , spoke 2858 protrudeslaterally (towards opposite lateral ends of the lysing tip) in bothdirections beyond a profile of the annular bead structure 2857. However,bead hub frame 2856 a does not protrude laterally in this manner. Spoke2858 also extends from bead hub frame 2856 a. However, other embodimentsare contemplated in which additional spokes may be used, in some suchembodiments in place of a bead hub frame 2856 a, as discussed below.Such annular shapes may be beneficial components may be less costly toproduce, they may withstand heat generated from the interaction ofelectrosurgical energy with tissue, and they may provide more benefitsfor dissecting the more delicate tissues such as those found in theabdomen including tissues attached to bowel and mesentery.

In this configuration, adjacent protrusions 2801 create recessions 2802in which recessed lysing rod 2860 may deliver electrosurgical energyduring a surgical procedure.

FIG. 28 d is a side view of lysing tip 2810 comprising support member2870, coupling tip 2863, spokes 2858 a/2858 b/2858 c coupling bead hub2856 with bead annular structure 2857.

FIGS. 28 e and 28 f illustrate perspective and side views of outer beads2851 coupled to outer bead sleeve 2880 through which lysing rod 2860extends. Bead hub 2856 may be formed on outer bead sleeve 2880, said hubcoupling to inner surface of annular structure 2857 via spokes 2858a/2858 b/2858 c.

Outer bead sleeves 2880 a/2880 b may comprise an internal and/or anexternal ledge that transition between a larger diameter portion and asmaller diameter portion of the outer bead sleeves. For example, outerbead sleeve may comprise an external sleeve ledge 2886 a and internalsleeve ledge (as illustrated in FIGS. 27 a-j , internal sleeve ledge2786 b). External sleeve ledge 2886 a may be configured to engage acorresponding internal bead ledge (as illustrated in FIGS. 27 a-j ,internal bead ledge 2759). within outer beads 2850 a/2850 b. Moreparticularly, outer bead sleeves 2880 a/2880 b may comprise twoconcentric holes with an internal bead ledge approximately half-waybetween the opposite openings. The internal bead ledge may be configuredto engage coupling tips 2863. This configuration creates a feature thatmay prevent lateral movement of outer beads 2851 a/2851 d off of outerbead sleeves 2881 a/2881 b.

FIG. 28 h illustrates how lysing rod, sleeve and bead may be assembled:Outer bead sleeve 2880 a may be extended into outer bead 2851 a stoppingat the point that external sleeve ledge 2886 a reaches the internal beadledge which may be followed by extension of lysing rod 2860 throughouter bead sleeve 2880 a stopping at the point coupling tip 2863 reachesthe internal sleeve ledge created by the larger-diameter inner sleevehole and smaller-diameter sleeve hole (as illustrated in FIGS. 27 a-j atinternal sleeve hole 2786 a and external sleeve hole 2786 b).

As depicted in FIGS. 28 a -L, lysing rod 2860 may be deformed prior tocoupling with bead sleeves in the areas to be coupled with the sleevessuch that the outer diameter of lysing rod 2860 may couple via frictionfit with the inner tunnel surface of middle bead sleeve 2881. Forexample, these regions may be flattened slightly or otherwise made intoa slightly elongated or oval shape so as to improve the ability of thesleeves to engage the lysing rod in these regions via friction fit. Inalternative embodiments, lysing tip 2810 may comprise protuberancespositioned on/coupled to lysing rod 2860, one protuberance, for example,may be positioned on each side of each middle bead 2851 c. Protuberancesmay serve to prevent or limit lateral movement of middle beads 2851b/2851 c on the lysing rod 2860 and/or may, depending upon aprotuberance pair's distance from a bead, serve to limit or preventrotation of beads around the axis of lysing rod 2860. In alternativeembodiments, one or more spacers (and such as those in FIGS. 11 a-f ,spacers 1162 a/b/c) may be used in place of protuberances 2865.Alternatively, middle bead sleeves 2881 may be more loosely coupled withlysing rod 2860 so as to allow for rotation of middle bead sleeve 2881thereon, and thereby allow for at least some rotation of theircorresponding beads on lysing rod 2860.

In alternative embodiments, the sleeve may be configured to have asingle cone-shaped tunnel that tapers and may engage coupling tip(similar to tunnel 2786′ in FIG. 27 j ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the bead.In alternative embodiments, lysing tip 2810 may be configured without asolid lysing rod and/or without spacers and/or welds and the likesimilar to that depicted in FIG. 17 k . Between beads, the hollow lysingrod may be deformed in a manner to prevent lateral movement of beadsand/or prevent rotation of beads. The hollow lysing rod may be deformedminimally or to a point that it is substantially flat. In suchembodiments, it may be preferable for the front edge to point distallyas the leading front edge. In such embodiments, screws may secure one orboth ends of the hollow lysing rod within outer beads 2851 a/2851 d. Theconfigurations of this alternative embodiment may be available for anyother similar embodiment contemplated herein.

FIGS. 28 i -L illustrate middle bead 2851 b/2851 c coupled to middlebead sleeve 2881 through which lysing rod 2860 extends and from whichmiddle band 2984 protrudes. Middle bead 2851 b may differ from outerbead 2851 a in that its length is truncated proximal to bead hub 2856terminating in knobs 2855. Knobs 2855 may inhibit the lysing tip 2810from catching tissue rather than cutting or separating it and/or maylimit rotation of middle bead 2851 around lysing rod 2860. The length ofmiddle bead 2851 b may be such that knobs 2855 and proximal portions ofbead hub 2856 may not contact support member 2870 in its relaxed stateand/or when the bead's proximal tip is pointing in the same direction aslysing tip 2810. However, in this embodiment, middle bead knobs 2855 maycontact support member 2870 if lysing rod 2860 is deformed during asurgical procedure and the middle bead 2851 is rotated about the lysingrod 2860 such that the top or bottom of the rear portion of the bead maycontact support member 2870. The spacing between middle beads 2851 andsupport member 2870 may be used to selectively limit the amount withwhich middle beads 2851 may rotate. In this embodiment, support member2870 may not serve as a backstop to permit a predetermined amount ofproximal movement of middle beads 2851 a/2851 b during a procedure.Middle bead sleeve may comprise raised band 2884 to engage the bead tolimit lateral movement.

FIGS. 29 a-f differs from that of 28 a-L in that middle beads 2951b/2951 c instead of terminating at knobs (knobs 2855 in FIGS. 28 a -L)define an annular shape having a flattened or slightly arced rear end2955 and outer beads comprise less bead hub frame material by directlyattaching the proximal portion of the distal tip to the bead hub 2256.

Adjacent protrusions 2901 create recessions 2902 in which recessedlysing rod 2960 may deliver electrosurgical energy during a surgicalprocedure.

FIG. 29 c is a side view of lysing tip 2910 comprising support member2970, coupling tip 2963, spoke 2958 a with direct connection points 2958g/2958 h coupling bead hub 2956 with outer bead 2951 a/2951 d annularstructure 2957.

In both middle and outer beads, a bead hub 2956 couples with itscorresponding sleeve. In middle beads, one or more spokes 2958 a/2958b/2958 c may extend from bead hub 2956 to the annular structure 2957 assupport and bead hub frame 2956 a by itself or in conjunction withspokes may couple the annular structure to bead hub 2956. As illustratedin FIG. 29 c , outer beads 2951 comprise bead hub 2956 coupled toannular structure 2957 by spoke 2958 a at the distal portion of the beadand direct coupling of bead hub 2956 to the material comprising internalportion of annular structure 2957 at direct connection points 2958 g and2958 h.

FIGS. 29 e and 29 f illustrate perspective views of outer bead 2951coupled to outer bead sleeve 2980 through which lysing rod 2960 extends.Bead hub 2956 may be formed on outer bead sleeve 2980.

Outer bead sleeves 2980 comprise a ledge 2986 that transitions between alarger diameter portion and a smaller diameter portion of the outer beadsleeves. Sleeve ledge 2986 may comprise an external sleeve ledge 2986 aand an internal sleeve ledge (as illustrated in FIGS. 27 a-j , internalsleeve ledge 2786 b). External sleeve ledge 2986 a may be configured toengage a corresponding internal bead ledge (as may be illustrated inFIGS. 27 a-j , internal bead ledge 2159). within outer beads 2950 a/2950b. Similarly, outer bead sleeves 2980 may comprise two concentric holeswith internal bead ledge approximately half-way between the oppositeopenings. Internal bead ledge may be configured to engage coupling tips2963. This configuration creates a feature that may prevent lateralmovement of outer beads 2951 a/2951 d off of outer bead sleeves 2980.

In alternative embodiments, the sleeve may be configured to have asingle cone-shaped tunnel that tapers and may engage coupling tip(similar to tunnel 2786′ in FIG. 27 j ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the bead.

As depicted in FIGS. 29 a-f , lysing rod 2960 may be deformed prior tocoupling with a middle bead sleeve such that the outer diameter oflysing rod 2960 may couple via friction fit with the inner tunnelsurface of middle bead sleeve 2981. In alternative embodiments, lysingtip 2910 may comprise protuberances positioned on/coupled to lysing rod2960, one protuberance, for example, may be positioned on each side ofeach middle bead 2951 c. Protuberances may serve to prevent or limitlateral movement of middle beads 2951 b/2951 c on the lysing rod 2960and/or may, depending upon a protuberance pair's distance from a bead,serve to limit or prevent rotation of beads around the axis of lysingrod 2960. In alternative embodiments, one or more spacers (and such asthose in FIGS. 9 a-9 e , spacers 962) may be used in place ofprotuberances 2965 which may be positioned at any angle on the crosssection of the lysing rod, in this depiction facing proximally 2965 c/dand distally 2965 a/b. Alternatively, middle bead sleeves 2981 may bemore loosely coupled with lysing rod 2960 so as to allow for rotation ofmiddle bead sleeve 2981 thereon, and thereby allow for at least somerotation of their corresponding beads on lysing rod 2960. In alternativeembodiments, lysing tip 2910 may be configured without a solid lysingrod and/or without spacers and/or welds and the like similar to thatdepicted in FIG. 17 k . Between beads, the hollow lysing rod may bedeformed in a manner to prevent lateral movement of beads and/or preventrotation of beads. The hollow lysing rod may be deformed minimally or toa point that it is substantially flat. In such embodiments, it may bepreferable for the front edge to point distally as the leading frontedge. In such embodiments, screws may secure one or both ends of thehollow lysing rod within outer beads 2951 a/2951 d. The configurationsof this alternative embodiment may be available for any other similarembodiment contemplated herein.

FIG. 29 f illustrates how lysing rod, sleeve and bead may be assembled:Outer bead sleeve 2980 may be extended into outer bead 2951 a stoppingat the point that external sleeve ledge 2986 a reaches the internal beadledge which may be followed by extension of lysing rod 2960 throughouter bead sleeve 2980 stopping at the point coupling tip 2963 reachesthe internal sleeve ledge 2986 b created by the larger-diameter innersleeve hole and smaller-diameter sleeve hole (as illustrated at internalsleeve hole 2787 a and external sleeve hole 2786 h in FIGS. 27 a-j ).

In FIGS. 30 a-k , the beads again define an annular shape, however,these beads may be configured to be wider, unlike beads previouslydiscussed which define in cross section an oval or circular shape, thusthe beads in this embodiment may define a more cross-sectionallyelongated shape and may be configured to have opposing upper and lowersurfaces defining the annular structure that are parallel or at leastsubstantially parallel in cross-section. These beads may be referred toas annular bands and may be flexible by way of material or a combinationof material and/or thicknesses and/or configuration such that they canbe compressed in some embodiments either from the top and bottom or fromthe opposing distal ends. In some embodiments, beads may be resilientlyflexible such that they naturally return to their original state afterbeing compressed. Various embodiments may enable greatercompressibility, for example, by removing and/or angling a bead spokebetween the bead hub and the annular structures 3057 of beads 3051a/b/c/d.

This ability to compress and be restored may be useful to allow thelysing tip 3010 to self-adjust during certain surgical procedures, inparticular those involving the intermixing of delicate tissues withdense/fibrous tissues (such as pre-existing scar), for example, in theabdomen attached to the bowel and/or mesentery. To illustrate with moreparticularity, upon being compressed from the top or bottom, the distaltip may be deformed to form a more acute angle of attack facilitatingtissue separation and the cross sectional profile along the height ofthe tip may be reduced. Similarly upon encountering more dense and/ormore fibrous tissue at the distal tip, the tip may slow or ceasemovement, however, the force from the surgeon's motion will continue topush the lysing segment closer to the more dense and/or more fibroustarget tissue effectively providing more enhanced power to lyse thetissue rather than requiring an increase of the power from theelectrosurgical generator. In some embodiments, this may also reduce theneed for increasing power from the electrosurgical generator in order tolyse and/or separate such tissues. This may also enhance safety becauseit may be safer for patient safety to operate electrosurgical generatorsat the minimum necessary power. FIGS. 30 a and 30 b illustrateperspective and upper views respectively of protrusions 3001, recessions3002, beads 3051 a/3051 b/3051 c/3051 d, lysing rod 3060, and supportmember 3070 partially comprising grasping pad 3071. FIG. 30 c is a sideview of lysing tip 3010 illustrating the side and middle beads 3051a/b/c/d and support member 3070. FIG. 30 d illustrates a middle bead3051 b or 3051 c with bead hub 3056 and spokes 3058 a/3058 b; other thanthe shape of the bead, its structure in coupling to the lysing rod 3060(middle and outer sleeves 3080 and 3081 respectively) is similar toouter beads 3051 a/2451 b and similar to the embodiments in FIGS. 27-29via coupling tip 3063. FIGS. 30 e-30 k illustrate perspective, sideelevation, and top plan views of an outer bead in relaxed and compressedstates. FIGS. 30 e /30 h/30 j illustrate bead 3051 a/3051 d in therelaxed and/or “as manufactured” state from perspective, side, and upperviews. FIGS. 30 f /30 i/30 k illustrate the same bead 3051 a/3051 d in acompressed state, thus, it is elongated along the beads BL axis aspreviously described in FIGS. 10 d and 10 e . FIG. 30 g illustratesouter bead sleeve 3080 on which outer bead 3051 a and/or 3051 d may becoupled.

Outer beads 3051 a/3051 d and middle beads 3051 b/3051 c comprise beadhub 3056 and annular structure 3057 coupled via only 2 spokes 3058a/3058 b terminating on annular structure 3057 proximally of bead hub3056. This configuration may allow lysing rod 3060 to move closer totissue located distally to deliver more concentrated electrosurgicalenergy when the most distal portion of outer bead annular structure 3057is inhibited in its distal progress by dense/fibrous tissue. In someembodiments, spokes may comprise a different material from the bead hub.Such material may be more flexible to allow for greater movement oflysing rod 3060. Alternatively, spokes 3058 a/3058 b may comprise thesame material and the flexibility may be provided by altering thethickness of the material.

As depicted in FIGS. 30 a-k , in order to prevent lateral movement ofmiddle beads, lysing rod 3060 may be deformed prior to coupling with amiddle bead sleeve such that the outer diameter of lysing rod 3060 maycouple via friction fit with the inner tunnel surface of middle beadsleeve 3081. In alternative embodiments, lysing tip 3010 may compriseprotuberances positioned on/coupled to lysing rod 3060, oneprotuberance, for example, may be positioned on each side of each middlebead 3051 c. In some embodiments, protuberance 3065 may be positioned toface in any direction, including distally and proximally. Protuberancesmay serve to prevent or limit lateral movement of middle beads 3051b/3051 c on the lysing rod 3060 and/or may, depending upon aprotuberance pair's distance from a bead, serve to limit or preventrotation of beads around the axis of lysing rod 3060. In alternativeembodiments, one or more spacers (and such as those in FIGS. 11 a-11 e ,spacers 1162) may be used in place of protuberances 3065. Alternatively,middle bead sleeves 3081 may be more loosely coupled with lysing rod3060 so as to allow for rotation of middle bead sleeve 3081 thereon, andthereby allow for at least some rotation of their corresponding beads onlysing rod 3060.

In FIG. 30 b , the end tip of support member 3070 may be coated with anon-conductive coating, thus, the area of relative protrusion 3001 maybe wider and may perform more blunt dissection than if the end tip werenot so coated.

In alternative embodiments, the sleeve may be configured to have asingle cone-shaped tunnel that tapers and may engage coupling tip(similar to tunnel 2786′ in FIG. 27 j ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the bead.

As depicted in FIGS. 31 a-e , alternative embodiments are contemplatedin which free-floating lysing tips may instead be modified so as to becoupleable with actuation rod pairs 3121/3123 and 3122/3124 and/or oneor more cannulas 3131 and/or 3132 as set forth herein such that thefree-floating lysing tips become non-free-floating lysing tips, as shownin FIGS. 31 a-e . The figures only differ from one another as to thestyle of bead. In all configurations, bead length may be limited toensure that lysing tip may rotate sufficiently into a deliveryconfiguration that permits entry and egress of the lysing tip through anouter cannula and/or an entrance incision. FIGS. 31 a and 31 b depictbeads 3151 e-h which may be similar or identical to the middle beads ofFIG. 28 , namely 2851 b/2851 c. FIG. 31 c depicts beads 3151 i-L whichmay be similar or identical to the middle beads of FIGS. 27 a-j , namely2751 b/2751 c. FIG. 31 d depicts beads 3151 m-p which may be similar oridentical to the middle beads of FIGS. 29 a-f , namely 2951 b/2951 c.FIG. 31 e depicts beads 3151 q-t which may be similar or identical tothe middle beads of FIGS. 30 a-k , namely 3051 b/3051 c. Support member3170 is coupled to the lysing rod supporting the beads.

Any of the configurations of FIGS. 31 a-e may comprise canal(s) 3104(shown in FIG. 31 a only) which may be positioned to supply one or morefluids to the surgical site around or near lysing tip 3110 via a portlocated adjacent to the internal device cannula and/or lysing tip. Canal3104 may be configured to be extended and withdrawn as needed. Inalternative embodiments, other fluids that may pass down canal 3104 mayinclude, but not be limited to, cold nitrogen gas, fluorocarbons, etc.,which might cool and/or freeze tissue to alter it in a desired fashion.

FIGS. 32 a /32 b/32 c illustrate a tissue modification tip (TMT) system3200 comprising center-mounted actuation rod 3221, side actuation rod3222 coupled to proximal actuation rod 3224, inner cannula 3231 andouter cannula 3232 and a TMT 3211 comprising energy window array 3213and tip cover 3212. FIG. 32 b illustrates the tip in the intermediateposition between the delivery and treatment configurations. FIG. 32 cillustrates the tip recessed within inner cannula 3231. In alternativeembodiments, TMT 3211 may be configured such that it may not be able torecess within inner cannula 3231. Isolated energy window(s)/termini3213′ may be any shape or configuration of shapes so long as they areelectrically isolated relative to the tissue being exposed.

In some embodiments, energy window array 3213 may comprise multipleisolated energy window termini 3213′ through which energy is dischargedto multiple locations on the exposed tissue at the same time. The tip ofeach isolated energy window termini 3213′ may extend above the topsurface of cover 3212 to attain a desired effect and/or be slightlyrecessed relative to cover 3212. The energy discharged may beelectrosurgical energy of any type or, more specifically, may be‘coagulation’ energy waveforms that are designed for an intended effect,for example, to incapacitate sweat glands and/or to tighten tissue, andthe like. The energy delivered through energy window array 3213, whichas in FIG. 32 a may be electrode termini, may be pulsed in order tocreate, as the TMT is in motion, intermittent islands of undamagedtissue to feed and nourish the damaged tissue areas back to health. Forexample, the electrosurgical generator may be programmed to deliver 120watts of ‘coag’ energy with a 40% duty cycle of 80 ms ON and 120 ms OFF.These settings might seem high if they were considered to be applied toa high density discharge device such as a bovie needle tip or a boviepaddle. However, 120 watts of ‘coag’ power pulsed at a 40% duty cycleapplied over 6 termini may yield an energy distribution per electrodetermini of under 8 watts.

In some embodiments, each of the energy window/termini 3213′ may becoupled with one another and with a common energy source so as to eachdeliver the modality of energy. Alternatively, one or more of the energywindows/termini 3213′ may be isolated both physically and electricallyand/or otherwise energetically such that different modalities of energymay be created and/or delivered through each window/termini as desired.

In alternative embodiments, TMT 3211 may be configured to befree-floating and couple with a grasping/control instrument as disclosedin FIGS. 33 a-f . Although, as discussed below, energy window 3312 doesnot comprise termini, this energy window may be replaced with energywindow termini as shown in FIG. 32 a . Similarly, the energy windowtermini shown in FIG. 32 a , may be replaced with the bar energy window3312 as depicted in FIG. 33 a -f.

System 3200 may comprise canal(s) 3204 which may be positioned to supplyone or more fluids to the surgical site around or near TMT 3211 via aport located adjacent to the internal device cannula and/or lysing tip(show in FIG. 32 a only). Canal 3204 may be configured to be extendedand withdrawn as needed. In alternative embodiments, other fluids thatmay pass down canal 3204 may include, but not be limited to, coldnitrogen gas, fluorocarbons, etc., which might cool and/or freeze tissueto alter it in a desired fashion.

FIG. 33 depicts a TMT system 3300 comprising a free-floating tissuemodification tip (TMT) 3311 that may couple to grasping/controlinstrument 3391. In this embodiment, grasping tab 3318 may be coupled toone or more energy windows 3312 that may be positioned to face an upperand/or lower tissue plane that may have already been lysed/dissected.Cover 3313 may have one or more windows 3313′ that may comprise one ormore bars 3305 or other structural elements configured to separate anelongated energy window 3312 into a plurality of isolated energywindows. Although elongated energy window 3312 is in the shape of a bar,a wide variety of alternative shapes and sizes of energy windows and/orstructures for defining emission regions of energy windows may beprovided as desired. In some embodiments, cover 3313 may be formed witha plurality of circular openings such that elongated energy window 3312may be functionally similar or equivalent to the energy windows depictedin FIG. 32 . Cover 3313 may be over-molded onto baseplate 3315. Inalternative embodiments, the region of energy window 3312 may compriseone or more (a plurality of) energy emitters positioned in a manner tooptimize the intended tissue modification effect. Grasping tab 3318 maybe coupled with a grasping/control instrument through which energy mayflow through to energy window 3312. Grasping tab 3318 may be coupled atthe receiving slot 3397 between upper and lower jaws 3393/3394respectively.

For example as shown in FIG. 33 a , energy conduit 3309 may be coupledwith TMT 3311. Such an energy conduit may extend from energy window 3312and through, for example, grasping tab 3318 or otherwise through baseplate 3315 of TMT 3311. Energy conduit 3309 may in some embodimentsextend through an opening and/or tunnel formed in grasping/controlinstrument 3391. Alternatively, energy conduit 3309 may extend from TMT3311 up through a cannula (not shown) through which grasping controlinstrument 3391 may be delivered.

In alternative embodiments, the TMT system 3300 may be configured in anymanner to accommodate the delivery or creation of any energy modalityincluding, but not limited to, laser, intense pulse light, resistiveheating, radiant heat, thermochromic, ultrasound, mechanical, and/ormicrowave. In some embodiments, the particular type of energy may begenerated away from the TMT device and delivered to the TMT tip 3311 viaone or more conduits 3309. Alternatively, the TMT or the assemblysupporting the TMT may contain components for example, at or near energywindow conduit 3315, that when activated with another energy, forexample, AC and/or DC power and/or laser, may generate the desiredenergy type at the TMT energy window 3312. In some embodiments, theseenergy modalities may be delivered through or components that generate aparticular energy type in TMT 3311 powered through grasping tab 3318,which energy may be delivered into/onto the one or more energy windows3312. In some embodiments, such energy may be delivered by providing oneor more energy delivery conduits such as 3309.

A tip energy window tongue 3319 may be formed in tip 3311. For example,tip energy window conduit(s) 3304 m may terminate at a proximal end of agrasping pad 3318. Alternatively, a tongue or the like may be formed ina grasping/control instrument and configured to be received in acorresponding slot/conduit formed in tip 3311. A correspondinginstrument 3391′ energy window slot or conduit(s) 3304 f may terminatewithin one or both jaws 3393/3394 or within instrument 3991′ (lower jaw3394 is not shown to facilitate viewing of other components). Thus, oncejaws 3393/3394 have grasped or is about to grasp grasping pad 3318, theone or more energy-related conduits 3304/3304 a may be aligned to allowfor delivery of a desired form of energy therethrough. In someembodiments, a portion of one or both of the energy window conduits mayprotrude from either the tip or the instrument such that the protrudingportion may be received in a corresponding female portion of the energywindow conduit to form a secure connection. Thus, in the depictedembodiment, protruding tongue 3319 extends from the proximal portion ofgrasping pad 3318 and is configured to be received within a distalportion of instrument energy window conduit 3304 f formed within adistal portion of instrument 3391′ adjacent to jaws 3393/3394 and/orreceiving slot 3397 of grasper 3391′.

In the depicted embodiment, 3347 represents an antenna configured todeliver a signal to a receiver unit. Antennae 3347 may be located withinhole 3355 b. In some embodiments, antenna 3347 may compriseradiofrequency identification (RFID) TAG. In some embodiments the RFIDtag may comprise an RFID transponder. In other embodiments the RFID tagmay comprise a passive tag. It should be understood that antenna 3347 isnot depicted in every one of the other figures; any of the embodimentsdescribed herein may comprise one or more such elements. Otherembodiments may comprise one or more antenna on any other suitablelocation on the embodiment, including but not limited to on the TMT orgrasper tip or shaft. In embodiments in which antenna 3347 comprises anRFID transponder, the RFID transponder may comprise a microchip, such asa microchip having a rewritable memory. In some embodiments, the tag maymeasure less than a few millimeters. In some embodiments a reader maygenerate an alternating electromagnetic field which activates the RFIDtransponder and data may be sent via frequency modulation. In anembodiment, the position of the RFID tag or other antenna may bedetermined by an alternating electromagnetic field in the ultra-highfrequency range. The position may be related to a 3 dimensional mappingof the subject. In an embodiment the reader may generate an alternatingelectromagnetic field. One or more receiver units may be set up toreceive the signal from the tag. By evaluating, for example, thestrength of the signal at various receiver units, the distances from thevarious receiver units may be determined. By so determining suchdistances, a precise location of the lysing tip relative to a patientand/or a particular organ or other surgical site on the patient may bedetermined. In some embodiments, a display screen with appropriatesoftware may be coupled with the RFID or other localization technologyto allow a surgeon to visualize at least an approximate location of thetag/antenna, and therefore the lysing tip, relative to the patient'sbody.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 3348 may befurther coupled with one or more RFID tags. One or more sensors 3348 maybe located within one or more holes 3355 a or may be located on anyother suitable location on the embodiment, including but not limited toon the TMT or grasper tip or shaft. As such, data from the one or moresensors may be paired or otherwise used in connection with data from theone or more RFID tags or other antennas. For example, some embodimentsmay be configured to provide information to a surgeon regarding one ormore locations on the body from which one or more sensor readings wereobtained. In some embodiments, temperature sensors may includethermistors and/or thermocouples. To further illustrate using anotherexample, information regarding tissue temperature may be combined with alocation from which such tissue temperature(s) were taken. In thismanner, a surgeon may be provided with specific information regardingwhich locations within a patient's body have already been treated in aneffective manner and thus which locations need not receive furthertreatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 3348 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis.

In alternative embodiments which may be helpful for skin/cosmeticprocedures, the TD tip and/or the anticipated and/or previous paths maybe visualized using for example an internal camera such as an endoscopicor laparoscopic camera, and/or an external camera such as an infraredcamera, (for example, a FLIR camera), an RFID tag or other antenna. Insome implementations, such a device or devices may be positioned on theTD. In other implementations such a device or devices may be separatefrom the TD. A real time display may be created using the data of thecameras and/or antennae and/or tags, for example, showing the exactlocation of the tip and the during- and post-passage temperatureeffects. In alternative embodiments, the software presenting the visualinformation may hold (or slow the decay back to the body temperature)the color (designating temperature) at its maximum value during theremainder of the procedure so that the surgeon will know where the TDtip has been.

In some embodiments, the modular TMT 3311 may be used in a surgicalprocedure similar to that shown in FIGS. 35 a-f . In such embodiments,it may be helpful to form a protrusion on the top and/or bottom of tab3318. This may allow for rotation of TMT 3311 while it is in the jaws ofa suitable instrument 3314 g/3390 similar to engagement betweenprotrusions 3570 t′ and 3570 b′ with jaws 3593 and 3594 respectively asdepicted in FIG. 35 a -35 f.

FIGS. 34 a-34 i comprises dissector/tissue clamp system (D-TC) 3400 thatis configured to be deployed through cannula 3432 in a deploymentconfiguration in which two opposing portions 3405 a/3406 a of D-TC tip3410 extend substantially parallel to the axis of cannula 3432. Moreparticularly in the depicted embodiment D-TC tip 3410 comprises a firstportion 3405 a that nests with a second portion 3406 a in the deploymentconfiguration. First portion 3405 a is configured to pivot with respectto second portion 3406 a when D-TC tip 3410 is reconfigured from itsdeployment (also a treatment-clamping configuration) to one of its othertreatment configurations. The deployment configuration is depicted inFIGS. 34 c /34 d. A first treatment configuration is shown in FIG. 34 a; this treatment configuration may be referred to herein astreatment-dissecting configuration which may correspond with treatmentconfigurations of other embodiments previously described. A secondintermediate treatment configuration is shown in FIG. 34 b ; in thisconfiguration, two tip portions 3405 a/3406 a are angled with respect toone another to prepare for capturing a vessel and/or duct 8. A thirdtreatment configuration is shown in FIG. 34 c ; in this configuration,the duct and/or vessel 8 may be clamped in between the two tip portions(not shown). After performing this treatment, the D-TC tip 3410 may bewithdrawn into cannula 3432 in this same configuration after theduct/vessel 8 has been severed. Thus, the configuration depicted in FIG.34 c may also be considered a deployment configuration once theduct/vessel 8 has been severed. FIG. 34 b depicts D-TC tip 3410 as it isbeing reconfigured between deployment and treatment configurations orvice versa. As previously described, this intermediate configuration mayalso be considered a treatment configuration. For example, theconfiguration depicted in FIG. 34 b may be used to treat tissuepositioned adjacent to one or both of the tip portions 3405 a/3406 awithout clamping/closing the jaws completely in some implementations.The pivoting of the tip portions 3405 a/3406 a may be done by using oneor more control arms. In the depicted embodiment, the first control arm3420 may be coupled at a pivot point 3420′ between first portion 3405 aand second portion 3406 a. Thus, by advancing or retracting control arm3420, first portion 3405 a and second portion 3406 a may be open andclosed like jaws. Additional control arms may be used in someembodiments to passively control the positioning of the two tipportions. Thus, upper control arm 3421 may be pivotably coupled withfirst portion 3405 a and lower control arm 3422 may be coupled withsecond portion 3406 a. Upper and lower control arms 3421 and 3422respectively may be pivotably coupled at their opposite ends at pivotbase 3420′ coupled to the inner sides of each first and second portion3405 a/3406 a. The active control arm 3420 may extend through theinner/device cannula 3431 and may be manually controlled by a surgeon.In some embodiments, the active control arm 3420 may be operably coupledwith an actuation component such as a control handpiece.

As depicted in FIG. 34 f , first portion 3405 a and second portion 3406a may comprise nonconductive covering 3405 b and 3406 b respectivelywhich each are configured to receive electrode 3405 e and 3406 erespectively and their electrode segment(s). Pivot 7 and 7′ in theelectrodes of first portion 3405 a and second portion 3406 a may becoupled to control arm 3420. Additionally, pivots 3416 and 3416′positioned on electrodes 3405 e/3406 e may be coupled with upper controlarm 3421 and lower control arm 3422 respectively. FIG. 34 g depicts arear view of all components coupled together.

In an example of a method for treating tissue using the system of FIGS.34 a-34 i , the D-TC tip 3410 may first be delivered through cannula3432 in its delivery configuration as shown in FIG. 34 d . D-TC tip 3410may then be advanced through the distal end of cannula 3432 as shown inFIG. 34 c . The opposing portions or jaws of the D-TC tip 3405 a/3406 amay then be opened or at least partially opened as in FIG. 34 b . If itis desired to use D-TC tip 3410 as a dissector/lysing tip, the opposingportions 3405 a/3406 a may be fully opened such that they are alignedperpendicular to or at least substantially perpendicular to the axis ofthe cannula as shown in FIG. 34 a . D-TC tip 3410 may then be used inany of the procedures as previously described. If, on the other hand, itis desired to use D-TC tip 3410 in order to clamp/seal a blood vessel orduct 8, the open opposing jaws 3405 a/3406 a may be positioned about ablood vessel or duct 8 (as shown in FIG. 34 b ). In some suchimplementations, the opposing tip portions 3405 a/3406 a may not befully opened as shown in FIG. 34 a . The opposing jaws 3405 a/3406 a maythen be at least partially closed onto the blood vessel or duct 8 inorder to clamp the blood vessel and then electro-cut/electro-coagulatethe blood vessel or duct 8 into opposing severed ends and/or acrushed/coagulated central portion of the blood vessel with opposingends.

FIG. 34 h depicts a bipolar embodiment of system 3400 that includes theD-TC tip 3410 b. Upper portion 3405 a′ is configured to be electricallyisolated from lower portion 3406 a′ including the control arm 3420 b andmiddle hinge 3420 b′. Upper portion 3405 a′ is coupled to energy conduit3468 n while lower portion 3406 a′ is coupled to energy conduit 3468 p.Energy conduits 3468 n/3468 p may lead proximally and may enter and exitthrough holes 3431 h in inner device cannula 3431. D-TC tip 3410 b maybe used in its open/treatment configuration as shown in FIG. 34 h todissect tissues and tissue planes. When upper and lower portions 3405 a′and 3406 a′ are in the closed or substantially closed position as shownin FIGS. 34 b /34 c, system 3400 may be used to clamp/seal a bloodvessel or duct.

FIG. 34 i depicts an alternative embodiment that is similar to theembodiment depicted in FIG. 34 h , however, it is configured such thatevery other lysing segment may be of a polarity opposite to the polarityof its adjacent lysing segment at any one time. In some embodiments,each of 5 lysing segments 3403 a-3403 e may be electrically isolatedfrom one another. Energy conduit 3468 n′ may be electrically coupled to2 lysing segments 3403 b/3403 d while energy conduit 3468 p′ may beelectrically coupled to 3 lysing segments 3403 a/3403 c/3403 e.

FIGS. 35 a-35 f depict yet another embodiment of a CDTD system 3500.However, as previously mentioned, other embodiments are contemplated inwhich system 3500 need not utilize a cannula and therefore may beconsidered a non-CDTD system. System 3500 comprises a lysing tip 3510that is configured to be completely separable from any other element ofthe system and may therefore be referred to herein as a “free-floating”lysing tip. Lysing tip 3510 may comprise a plurality of beads 3551 a-dand recessions 3502 between each bead pair. Lysing member 3560 (notvisible, as covered by spacers 3561 a/b/c), which in the depictedembodiment comprises a lysing rod 3560, is enclosed or may be partiallyenclosed by spacers 3561 a/3561 b/3561 c positioned in recessions 3502,as previously described. Each of the portions of lysing member 3560extending between adjacent beads 3551 a/b/c/d defines a lysing segment.

As also previously mentioned, a grasping/control instrument 3590 mayextend through a cannula 3532 to allow for grasping and/or control oflysing tip 3510 during an electrosurgical procedure. Grasping/controlinstrument 3590 may comprise one or more jaws configured to couple withsupport member 3570. As previously mentioned, in the depictedembodiment, support member 3570 comprises a bow shape extending betweenopposing ends of the support member 3570 and is coupled with lysingmember/rod 3560 at or near such opposing ends.

In the depicted embodiment, grasping/control instrument 3590 comprisesan upper jaw 3593 and a lower jaw 3594. One or both of these jaws maycomprise a projection or opening configured to facilitate coupling withlysing tip 3510 by way of a mating opening/projection formed on thelysing tip 3510. Thus, support member 3570 comprises an upper projection3570 t′ and a lower projection 3570 b′. One or both of these projectionsmay comprise a faceted and/or keyed shape to facilitate coupling oflysing tip 3510 with instrument 3590 in a particular rotationalorientation. Preferably, this shape allows for repositioning of lysingtip 3510 at any of a plurality of preconfigured rotational positions.Thus, as shown in FIG. 35 d , upper projection 3570 t′ comprises aplurality of flattened or faceted surfaces that may mate with acorresponding plurality of flattened or faceted surfaces formed withinan opening 3593 h formed in a lower surface of upper jaw 3593. A varietyof alternative non-circular projection/opening pair shapes will beapparent to those of ordinary skill in the art after having received thebenefit of this disclosure.

In some embodiments, one of the projection/opening pairs may beconfigured to lock the lysing tip in a particular rotational orientationand the other may be configured to allow the lysing tip to rotate whilethe projection is seated within the opening. For example, as also shownin FIG. 35 d , lower projection 3570 b′ may comprise a rounded and/orsmooth shape to allow for rotation when positioned within acorresponding opening (not shown in the figures) formed within an uppersurface of lower jaw 3594. By providing one projection/opening pair thatallows for rotation and another than locks the lysing tip in aparticular rotational orientation, a surgeon may be able to release thelocking projection/opening coupling while maintaining the rotatingprojection/opening pair coupling, rotate the lysing tip, and thenre-lock the lysing tip in a different rotational orientation withoutcompletely releasing the lysing tip from the instrument.

However, a wide variety of alternative embodiments are contemplated. Forexample, although the protrusions are depicted in FIGS. 35 a-35 f asformed on the lysing tip 3510, in alternative embodiments they mayinstead be formed on the grasping/control instrument 3590 and theopenings instead formed on the lysing tip 3510. In addition, a singleprojection/opening pair may be used instead of two separate pairs insome contemplated embodiments. In addition, in some embodiments, thelysing tip 3510 may be configured to rotate while fully grasped byinstrument 3590. In other words, both protrusion/opening pairs may bespherical and/or rounded or only a single such protrusion/opening may beused.

In an alternative embodiment, protrusions 3570 t′ and 3570 b′ may belocated toward the side of support member 3570′ thus allowing a sharperangle between the axis of the lysing tip and the axis of thegrasper/control instrument. Thus, the combined system may yield asmaller cross section during the deployment configuration through acannula.

Yet another embodiment of a free-floating lysing tip 3610 is depicted inFIGS. 36 a-36 e . This embodiment again comprises a plurality of beads3650 extending along a lysing member 3660 comprising a lysing rod.However, the beads 3651 a and 3651 b are positioned in between opposing,fixed protrusions 3676 a and 3676 b formed at opposite ends of lysingmember 3660. As best seen in FIG. 36 d , protrusions 3676 a and 3676 bare fixedly coupled with or, in some embodiments, an integral part of,support member 3670 at opposing ends of support member 3670. Thus,although inner beads 3651 a and 3651 b may be configured to rotate, atleast partially, with respect to lysing member 3660 and/or lysing tip3610, outer protrusions 3676 a and 3676 b may instead be fixed.

As previously described, a plurality of spacers 3661 a, 3661 b, and 3661c may be positioned in between each adjacent protrusion (such protrusioneither being a bead or a fixed protrusion) along lysing tip 3610. Inaddition, opposing ends of lysing member 3660 may be formed withcoupling tips 3664 to facilitate coupling of lysing member 3660 withouter protrusions 3676 a and 3676 b.

Coupling tips 3664 may have diameters larger than the inner diameter oftheir corresponding tunnels 3673 in outer protrusions 3676 a/3676 brespectively. The coupling tips 3664 may take various shapes, such as aball, as depicted in FIG. 36 b or, for example, a mushroom cap. In thedepicted embodiment, both of outer protrusions 3676 a/3676 b comprises arecess 3670′ that may have a larger diameter or other largest dimensionthan tunnels 3673 so as to accommodate/seat coupling tips 3664. Couplingtips 3664 may be made by, for example, liquefying the ends of lysingmember 3660 by LASER and/or other heating methods. Alternatively,coupling tips 3664 may comprise separate structural elements, such asscrew-on nuts or the like. In some embodiments, it may be desirable toprovide features and/or elements that inhibit or limit the ability ofthe electrosurgical energy to discharge from the opposing ends of thelysing rod. Thus, in some such embodiments, coupling tips 3664 may becoated or covered with a suitable insulating material such as an epoxywith non-conductive properties.

Although in the depicted embodiment, outer protrusions 3676 a/3676 b arefixedly attached to support member 3670, it is contemplated that theseprotrusions may, in some alternative embodiments, be converted to beadsby using bead structures that are loosely coupled with the ends ofsupport member 3670 so as to provide for space in between thesestructures and support member 3670 so as to allow for a predeterminedamount of rotation of these outer protrusions/beads, similar to innerbeads 3651 a/3651 b.

Still another example of a free-floating lysing tip 3710 according toother embodiments is depicted in FIGS. 37 a-37 e . In this embodiment,both of outer beads 3751 a/3751 d comprise an inner recess 3758 r toallow for respective opposing portions of support member 3770 to nesttherein. This configuration may be useful to prevent the opposing tipsof support member 3770 from discharging electrosurgical energy in anundesirable manner because these tips are nested within outer beads 3751a and 3751 d. Although in the depicted embodiment opposing portions ofsupport member 3770 are configured to be tightly or rigidly receivedwithin recesses 3758 r, alternative embodiments are contemplated inwhich one or both of these recesses may be formed slightly larger thantheir respective support member 3770 arms to allow for a predeterminedamount of rotation. For example, by adjusting the “height” of recesses3758 r (defined between upper and lower surfaces of lysing tip 3710perpendicular to the length of outer beads 3751 a and 3751 d betweentheir respective leading and trailing ends), rotation may be allowedalong an axis defined by lysing member 3760. However, by adjusting thelength and/or depth of recesses 3758 r, possibly along with thedimensions of the tunnels 3758 h formed therein, rotation along otheraxes may be permitted, such as rotation along an axis normal to the axisof the lysing member 3760 (resulting in swinging of the leading ends ofthe outer beads 3751 a and 3751 d to the left and right).

As previously described, a plurality of inner beads are also formedalong lysing member 3760, namely, inner beads 3751 b and 3751 c. Theseinner beads 3751 b and 3751 c comprise a flattened trailing endpositioned adjacent to a distal portion of support member 3770. As alsopreviously described, in some embodiments, the distance between supportmember 3770 and inner beads 3751 b and 3751 c may be selected so as toallow a predetermined amount of flexing of lysing member 3760 during anelectrosurgical procedure.

In addition, opposing ends of lysing member 3760 may be formed withcoupling tips 3764 to facilitate coupling of lysing member 3760 withouter beads 3751 a and 3751 d. Lysing member 3760 may extend throughtunnels 3758 h extending through outer beads 3751 a and 3751 d. As shownin FIG. 37 e , on the outer side of outer beads 3751 a and 3751 d, asecondary recess and/or ledge 3751L may be formed so as to allowcoupling tips 3764 to be received within this recess and engage ledge3751L without entering tunnel 3758 h.

Finally, a plurality of spacers 3761 a, 3761 b, and 3761 c may bepositioned in between each adjacent bead along lysing tip 3710.

Another example of a free-floating lysing tip 3810 is shown in FIGS. 38a-38 c . Lysing tip 3810 is depicted coupled with a grasping/controlinstrument 3890 a/b in FIG. 38 a . Lysing tip 3810 comprises a pluralityof beads 3851 positioned along a lysing rod 3860. Although each of beads3851 comprises a frusto-ellipsoidal shape having respective flattenedtrailing ends, any of the other bead shapes disclosed herein may besubstituted for these beads as desired in alternative embodiments.Lysing tip 3810 differs from the previously-described embodiments inthat lysing rod 3860 comprises opposing coupling tips 3869 configured tofacilitate coupling of lysing tip 3810 with one or two grasping/controlinstruments and corresponding holes or recesses 3891 h. For example,some embodiments may comprise a grasping/control instrument comprisingopposing arms 3891L and 3891R comprised of receiving holes or recesses3891 h at the distal ends which are configured to receive and capturelysing rod coupling tips 3869. Opposing arms 3891L/3891R may in someembodiments comprise jaws that may be selectively moveable relative toone another. Thus, a surgeon may open these arms/jaws to position themat opposite ends of lysing tip 3810 adjacent to coupling tips 3869 andthen close arms 3891L/3891R such that coupling tips 3869 may be trappedwithin a corresponding shaped hole and/or recess 3891 h placed in thetips of the jaws of one or more grasping instruments on closure.Alternatively, arms 3891L/3891R may extend from distinct graspingcontrol instruments that may use lysing tip 3810 to perform anelectrosurgical procedure in unison.

FIG. 38 b depicts a detailed view of the interface between modulargrasping instrument 3814 g, distal tip of shaft 3896 and pushrod 3897 ofa surgical instrument, and tip 3814 t together, the modular surgicaltool 3814. As shown in this figure the distal end of pushrod 3897 maycomprise a locking feature 3898. Locking lumen 3899′ comprises a slot3899 s configured to receive locking feature 3898 at a predeterminedrotational configuration. Upon aligning locking feature 3898 with slot3899 s, pushrod 3897 and shaft 3896 may be advanced into locking lumen3899′. After advancing pushrod 3897 to terminal end of slot, pushrod3897 and its accompanying pushrod locking feature 3899 n may be rotatedto lock pushrod locking feature 3899 n in place within locking chamber3899 n′. In some embodiments, the extent of the rotation of lockingfeature 3898 within locking feature chamber 3898′ and/or pushrod lockingfeature 3899 n may be the same as the extent of rotation of lockingfeature 3898 which may in some embodiments be 90 degrees. In someembodiments, pushrod locking feature 3899 n may comprise a plate or anelongated box or any other feature lacking rotational symmetry about theaxis pushrod 3897. Locking chamber 3899 n′ may comprise for example abox or other similar feature given to engage pushrod locking feature3899 n upon rotation of pushrod 3897.

Locking chamber 3899 n′ is coupled with coupling rod 3892 via holeswhich in turn may be coupled with one or more locking teeth 3895 formedwithin one or both jaws 3893 a/3893 b. Thus, upon advancing orretracting pushrod 3897, coupling rod 3892 advances or retracts toadvance or retract locking tooth/teeth 3895 so as to fix in placesupport member 3870 within slot 3893 h of upper jaw 3893 a. One or bothof jaws 3893 a/3893 b may in some embodiments also be moveable withrespect to the other jaw. In some such embodiments, the moveable jaw orjaws may be manually opened to allow for receipt of support member 3870therein. The moveable jaw or jaws may then be closed and the lockingtooth/teeth 3895 actuated to lock the support member at a desiredrotational orientation such as a delivery configuration such as depictedin 38 c. Then upon retracting the lysing tip into a patient's body, thelocking tooth 3895 may be released to allow the lysing tip to be rotatedto a treatment configuration. Such rotation may be accomplished by, forexample, using an organ or another surgical instrument for leverage toreorient the lysing tip between delivery and treatment configurations.

As previously mentioned, in some embodiments, spacers 3861 may bepositioned in between each two adjacent beads 3851 to restrict the beads3851 to a confined region along lysing rod 3860 and/or limit orselectively facilitate rotation of the beads 3851 along lysing rod 3860.Although not depicted in the drawings, in some embodiments, outerspacers may be provided in between the two outer beads and theirrespective, adjacent coupling tip 3869. Alternatively, coupling tips3869 may be positioned to contact the outer surface of both outer beadsor the tunnels (not shown) extending through the outer beads and/or thediameter of the lysing rod 3860 may taper to provide for a suitablefriction fit between the outer beads and the lysing rod 3860.

In some implementations of methods for manufacturing the lysing rod 3810of FIGS. 38 a and 38 b/c, lysing rod 3860 may initially comprise a wiredefining a cylindrical shape, or similar shape, along its entire length.Each of the various beads 3851 and, in some embodiments, spacers 3861 asneeded, may then be strung along lysing rod 3860 and positioned asdesired. Then, in order to form coupling tips 3869, opposing ends oflysing rod 3860 may be flattened and formed with a suitable hole and/ornotch as desired. Lysing rod 3860 may be held in place on support member3870 via loop 3877.

FIGS. 39 a-39 e depicts yet another example of a modular instrument/tip3900 configured to be coupled with a surgical instrument. Modularinstrument/tip 3900 comprises middle beads 3951 i and outer beads 39510coupled to lysing tip 3910 that may permanently couple with a modularinstrument shaft 3991. As previously described in connection with FIGS.17L and 17 m, modular instrument shaft 3991 may be reversibly coupledwith a surgical instrument at its distal end such as by using a pushrodand the locking elements previously described. Once this coupling hastaken place, a handle or suitable actuator may be used to reposition apiston 3917 p between a first configuration in which lysing tip islocked at a predetermined rotational configuration and a secondconfiguration in which the lysing tip is allowed to be repositioned atany of a plurality of rotational orientations. More particularly, in thesecond configuration, the support member 3970 of the lysing tip isloosely received within a hole 3997 formed at the distal end of modularinstrument shaft 3991. Thus, in this configuration, lysing tip can berotated to a delivery configuration as shown in FIG. 39 d . Then, uponadvancing piston 3917 p, the lysing tip may be locked in this positionand delivered through an incision into a patient's body. After beingdelivered, piston 3917 p may be retracted to allow the support member toslide within hole 3997 and rotate the lysing tip to the treatmentconfiguration depicted in FIG. 39 c after which the piston 3917 p may beadvanced to lock the lysing tip in this position for performing anelectrosurgical procedure.

As also shown in FIGS. 39 d and 39 e , some embodiments may beconfigured to translate a proximal movement to a distal movement at ornear the lysing tip. This may be useful for example to allow for asqueezing motion of an instrument handle to be used to force anactuation member such as piston 3917 p′ distally rather than proximallyso as to allow a surgeon to lock lysing tip 3910 in place at a desiredrotational orientation. For example in FIG. 39 d , this may beaccomplished with an lever mechanism which may comprise fulcrum 3918 fon which pivots lever 3918 w which is pivotably attached to rods 3918 uand 3918L that each connect to distal piston 3917 p′ and proximal piston3919 p′ respectively. As another example in FIG. 39 e , this motiontranslation may be accomplished with a ratcheting mechanism which maycomprise toothed cog 3917 c positioned in between ratcheted rods 3917 uand 3917L. Locking feature 3998 may reversibly couple with the distaltip of a control instrument.

FIG. 40 depicts a flow chart of an optional implementation for the otherimplementations disclosed herein of an energy emission-sensor feedbackloop 4000 according to this disclosure: Step 4005 may comprise: settingone or more temperatures (a desired maximal temperature threshold, or arange). In other implementations one or more such temperatures may bepreset by the manufacturer. Step 4010 may comprise setting one or moreenergy levels to lysing member(s) of a TD and/or energy window of atissue modification tip (TMT) (a desired maximal energy threshold, or arange). In other implementations energy levels may be preset by themanufacturer.

Step 4013 comprises inserting the lysing tip through an entranceincision into the patient's body. In some implementations for example,step 4013 may comprise inserting the lysing tip via one or morecannulas. In some such implementations, the lysing tip may be deliveredthrough the cannula or cannulas in a delivery configuration and berotated/pivoted into a treatment configuration. Alternatively, thelysing tip may be inserted without using a cannula but instead agrasping/control instrument which may be a laparoscopic driver forexample. In the implementations comprising 2 cannulas, the inner andouter cannulas may be inserted through the entrance wound eithersimultaneously or sequentially. In some implementations, the lysing tipmay be free-floating such that it is inserted into the body and thencoupled with grasping/control instrument after being positioned in thebody. It should be understood that embodiments are contemplated whereinthe dimensions of the tip relative to a cannula 1431 may vary as forexample, as shown in FIGS. 14 k and 14L. In other words, the lysing tip1410 in the axial deployment configuration may be unable to be receivedwithin cannula 1431 such as shown in FIG. 16L or may be unable to bereceived within an inner cannula of two delivery cannulas as shown inFIG. 16 k . In embodiments comprising two cannulas, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only need to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Upon detecting that the tip has been rotatedto its treatment configuration, actuating the temperature sensors and/ortemperature feedback loop.

Step 4015 may comprise passing the TD or TMT through the target tissuearea. In some implementations, the TD and/or TMT may comprise one ormore sensors, such as temperature sensors. Alternatively or in addition,the sensor may be mounted in a position that always remains external topatient yet able to sense a residual energy release from the TD or TMTthrough tissue. Step 4020 may comprise applying electrosurgical energy.For example, in some implementations, electrosurgical energy may beapplied to one or more lysing members. In other implementations,electrosurgical energy may be applied to one or more energy windows. Insome implementations, such energy may be applied to both the lysingmembers and/or the energy window either simultaneously or sequentially.Step 4025 may comprise gathering sensor data, such as temperature data.Step 4030 may comprise comparing sensor data to one or more settemperature levels. Step 4035 may comprise, if the sensed temperatureexceeds the threshold, reducing the amount of energy delivered throughthe lysing member and/or TMT.

FIG. 41 depicts a flow chart of an implementation of a method forseparating and/or modifying tissue using a TD. In this particularimplementation, the use of combined data from the TD generated from atleast the temperature sensor and the antenna(s) may be used to providesuitable feedback to a user during treatment. In some implementations,the TD Wand may comprise a tip comprising a plurality of protrusions.One or more lysing member(s) may be positioned between at least twoadjacent protrusions among the plurality of protrusions. A temperaturesensor may be positioned on the TD. The temperature sensor may beconfigured to sense a temperature of at least one of tissue and fluidadjacent to the TD during an operation. The fluid of which a temperaturereading is taken may comprise, for example, fluid from adjacenttissue(s) and/or fluid introduced during the procedure by way of the TDand/or another device or procedure. The TD may also comprise anantenna(s) such as an RFID tag positioned on the TD. In someimplementations, the antenna(s) may be positioned on the tip and/ordistal end of the shaft, such as on a bottom surface of the tip and/ordistal end of the shaft. The antenna(s) may be configured to providelocation data regarding a location of the TD, such as a particularportion or region of the TD for example, during an operation orprocedure. Although method 4100 is shown in the figure beginning withstep 4105, it should be understood that any of the preliminary stepsdescribed above in connection with other implementations may beperformed in method 4100 as well. For example, one or more of steps(4005-4035) from method 4000 may be performed in method 4100 if desired.In some implementations, step 4105 may comprise: receiving data from theTD temperature sensor and/or a sensor not mounted on the TD but perhapsexternal to the patient. Step 4110 may comprise receiving data from theantenna(s) such as RFID tag data. Step 4115 may comprise combining thedata generated from at least the temperature sensor and the antenna(s).In some implementations, the data from the temperature sensor and theantenna(s) may be combined before it is received. In other words, a stepof “receiving combined data from the TD generated from at least thetemperature sensor and the antenna(s)” may comprise receivingprecombined data (data from the temperature sensor and the antenna(s)that was combined before it was received) or, alternatively, maycomprise separately receiving temperature data and antenna(s) data thatmay be combined to allow for one or more particular features orfunctionalities. The combined data may be used to allow a surgeon orother user to determine one or more regions within a patient's body thathave been adequately treated using the TD. For example, in someimplementations, the combined data may allow a user to visualize one ormore regions within a patient's body, such as one or more regions thathave been sufficiently treated. This may be accomplished, for example,by creating an image corresponding with one or more regions of apatient's body. Such image or images may be highlighted, receive colorchanges, or otherwise modified on a display to indicate to the userwhich regions have been adequately treated. In some implementations,such regions may correspond with regions comprising tissue that hasreached a predetermined threshold temperature.

One implementation of a method 4200 according to this disclosure foraccessing an organ and/or target tissue with the assistance of a TD isshown in FIG. 42 . In some implementations, surgeon(s) may need toaccess tissue and/or an organ to repair or treat it. In someimplementations, the skin surrounding the anticipated entrance wound forthe surgical area may be cleansed by, for example, with isopropylalcohol (degreaser) followed by germicidal chlorhexidine scrub. Then, alocal anesthetic may be applied (such as by injecting) 1%lidocaine+1:10,000 adrenaline to the skin. Although method 4200 is shownin the figure beginning with step 4205, it should be understood that anyof the preliminary and later steps described above in connection withother implementations and/or methods 4000 and 4100 may be performed inmethod 4200 as well. For example, one or more other steps of any of theother implementations described herein such as for example, steps4005-4035 of the method depicted in FIG. 40 and/or steps 4105-4140 ofthe method depicted in FIG. 41 may also be included in the methoddepicted in FIG. 42 .

Step 4205 may comprise, for minimally invasive procedures or minimallyinvasive entrance wounds, performing a limited incision capable ofaccommodating the most minimal dimension of a tip that will pass and/orcannula that will pass into the entrance incision For example, aspreviously discussed, the incision may have a length that is the same orsubstantially the same or slightly larger than the width of the tipand/or the diameter of the cannula. Step 4205 may be performed with, forexample, a #15 Bard-Parker™ Scalpel. This incision may be deepened byscalpel, scissors or other surgical instrument to enter the desired bodystructure or cavity. For larger approaches, such as open abdominalsurgery or trauma surgery step 4205 may comprise the initial skinopening or body cavity opening steps of such a procedure. In someimplementations, step 4205 may comprise making the skin incision usingthe lysing member comprising lysing member(s) of the TD. Step 4210 maycomprise applying one or more fluids to the tissues. In someimplementations, step 4210 may comprise applying fluids to the targettissue(s). In some implementations, embodiments with canals that maycarry fluids may be used as described herein, for example, canal 304 ofFIG. 3 a , and/or canal 1404 of FIG. 14 d . In alternative embodiments,other fluids that may pass down canal 304 may include, but not belimited to, cold nitrogen gas, fluorocarbons, etc., which might cooland/or freeze tissue to alter it in a desired fashion. In someimplementations, step 4210 may comprise applying fluids to the tissuesto be traversed en route to the target tissue, in addition to, or as analternative to applying fluids directly to the target tissue(s). Thisstep may be performed using for example canals 304 or 1404 depicted inFIGS. 3 a and 14 d respectively. In some implementations, the fluid(s)may comprise water. In some implementations, the fluid(s) may comprisean ionic fluid, such as a saline solution. The fluid(s) may be appliedto the tissue via, for example, injection, or TD fluid port or via aseparate cannula or catheter or via pouring or via spray. In someimplementations, the fluid(s) may comprise an ionic fluid and ananesthetic, such as a tumescent anesthesia. Non-ionic fluids may be usedin other implementations; such fluids may become more ionic by diffusionof some of the patients' ions present in the surgical field. In someimplementations step 4210 may comprise applying one or more fluids thatserve as an ionic fluid, and/or an anesthetic, and/or adrenaline. Insome cutaneous implementations, the fluid(s) may comprise a Klein and orother tumescent formula. In some implementations, the Klein formula andamount used may be about 100 cc of Klein Formula with saline, 0.1%lidocaine, epinephrine 1:1,000,000, and NaHCO₃@5 meq/L. Those ofordinary skill in the art will appreciate that this step will mosttypically be followed in connection with procedures involving skintissues. Other procedures may not require performing this step.

Step 4213 comprises inserting the lysing tip through an entranceincision into the patient's body. In some implementations for example,step 4213 may comprise inserting the lysing tip via one or morecannulas. In some such implementations, the lysing tip may be deliveredthrough the cannula or cannulas in a delivery configuration and berotated/pivoted into a treatment configuration. Alternatively, thelysing tip may be inserted without using a cannula but instead agrasping/control instrument which may be a laparoscopic driver forexample. In the implementations comprising 2 cannulas, the inner andouter cannulas may be inserted through the entrance wound eithersimultaneously or sequentially. In some implementations, the lysing tipmay be free-floating such that it is inserted into the body and thencoupled with grasping/control instrument after being positioned in thebody. It should be understood that embodiments are contemplated whereinthe dimensions of the tip relative to a cannula may vary as for example,as shown in FIGS. 14 k and 14L. In other words, the lysing tip 1410 inthe axial deployment configuration may be unable to be received withincannula 1431 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula 1431 of two delivery cannulas 1431 and 1432, asshown in FIG. 14 k . In embodiments comprising two cannulas, this may beuseful because if the lysing tip does not require substantial protectionand can remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only needs to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Such embodiments may be useful for cosmeticprocedures within the skin, for example, but not limited to, for facelifting and/or cellulite treatment.

Step 4215 may comprise a first sub-step that may be to activate theelectrosurgical generator to cause cutting and/or a blend of cutting andcoagulation energies to flow to the lysing member(s). The secondsub-step may be passing the TD through the various layers of tissue tocreate a path to a target organ. In some implementations, creating apath to a target organ or other target tissue may comprise creating apath from the incision to the target organ or other target tissue and/orcreating a path around the target organ or other target tissue to allowfor access to other regions of the target organ or other target tissue.In some implementations, the lysing member(s) may be used to inducefibrosis along the path, including along a path that may traverse theperimeter of the target organ/tissue. In some implementations, the TDand/or the anticipated path may be visualized using for example aninternal camera such as an endoscopic or laparoscopic camera. In somecutaneous and/or cosmetic implementations, an external camera such as aFLIR camera, an RFID tag or other antenna may be used. In someimplementations, such a device or devices may be positioned on the TD.In other implementations such a device or devices may be separate fromthe TD. In some implementations, heat may be produced or energy mayotherwise be released in the tissues through which the TD is passed. Insome implementations, heating portions of the tissues the TD passes bymay be undesirable. As such, in some implementations, undesirableheating of such tissues and/or adjacent tissues may be mitigated byapplying a cooling step antecedent and or concurrent with energydelivery with the TD. Such steps may comprise use of one or more coolingfluids delivered via the TD or one or more separate catheters orcannulas or endoscopes. Other cooling mechanisms may comprise a dynamiccooling system wherein a cool liquid or gel is actively pumped into orthrough a contact cooling object. Step 4220 may comprise identifyingcritical tissue that is not to be treated, such as important bloodvessels, nerves, ducts, organs or other anatomy along the path to thetarget organ/tissue and/or in the area surrounding the targetorgan/tissue. Step 4225 may comprise: adding additional fluids of thetypes previously described to the target and/or surrounding tissues viathe TD port(s) or via one or more separate catheters or cannulas orendoscopes. Step 4230 may comprise: expanding one or more regions of thepath to the target tissue. In some implementations, step 4230 maycomprise expanding one or more path(s) from the incision to the targettissue. In some implementations, step 4230 may comprise expanding aregion around the target tissue such as for example, via a fanningmotion. In some implementations, one or more of the other stepsdescribed herein using the TD may also be performed with a fanningmotion. In implementations using TDs with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TDs with nonaxially oriented protrusions, such afanning motion may comprise a side-to-side fanning motion; one exampleof a fanning motion using a TD having at least one nonaxially orientedprotrusion may comprise a ‘windshield wiper’ motion. In someimplementations step 4230 may further comprise activating the energy tothe TD, for example, the energy to the lysing member(s). Alternatively,in some implementations, an additional step 4231 may be used comprisingwithdrawing the lysing tip and inserting and activating a TMT for adesired effect, for example, tissue modification/tightening. Step 4235may comprise: observing for bleeding from larger vessels and achievinghemostasis as needed. In some implementations achieving hemostasis maybe accomplished by cautery, electrifying, ligating, or chemical methods.In some implementations, the surgeon may activate the electrosurgicalcoagulation energy to the lysing member(s) to achieve the hemostasis. Insome implementations, one or more other devices and/or suture may beused to achieve hemostasis for larger vessels.

Generally, step 4238 may comprise withdrawing the lysing tip. Forexample, step 4238 may comprise rotating the lysing tip such that itextends axially along the lumen of the one or more cannulas or at leastsubstantially axial to such lumen(s). In some implementations the lysingtip may be rotated at an angle with respect to such lumen so long as thelysing tip can be withdrawn through this cannula in this configuration.After rotating the lysing tip sufficiently such that it can be receivedwithin the cannula or cannulas, the lysing tip may be withdrawn throughthe entrance incision.

In some implementations not utilizing a cannula, the lysing tippreferably is again rotated such that the elongated axis of the lysingtip is aligned or at least substantially aligned with the direction ofwithdrawal. After such rotation, the lysing tip may be withdrawn throughthe entrance incision. In some such implementations, a surgeon mayrotate the lysing tip by palpation. Alternatively, an instrument may beused to perform the rotation and may be used to withdraw the lysing tipthrough the entrance incision. As previously mentioned, in someimplementations, a first instrument may release its coupling with thelysing tip and then a second instrument may be used to rotate and/orwithdraw the lysing tip. In alternative implementations, a cord, forexample, a suture and/or thread, may have been previously tied to a holein the lysing tip and may be used to pull the lysing tip throughentrance incision.

Step 4240 may comprise: removing the TD with power off and suturing thewound in the standard fashion. In some implementations, the tissuestraversed may require closure by suturing, stapling, gluing, and/oradhesive skin closure strips. In some implementations, organs and/ororgan systems that the TD may be useful to access may include but notlimited to skin, muscle, and/or parotid, and/or salivary gland, and/orthyroid, and/or lung, and/or heart, and/or gastrointestinal, and/orliver, and/or pancreas, and/or spleen, and/or gallbladder, and/orkidney, and/or adrenal, and/or prostate, and/or ovary, and/or uterus,and/or bladder, and/or vascular, and/or nervous, and/or lymph nodesand/or skeleton.

In some implementations, the TD may also aid in the treatment of traumavictims; for example, gunshot and/or blast injuries and/blunt forcetrauma. Such patients may be in shock and bleed to a greater degree thannormal due to systemic changes, some changes of which may consume and/oralter platelets and/or clotting proteins in the blood. It may bebeneficial for surgeons to reach a vigorously bleeding area more rapidlywhile achieving a degree of hemostasis by coagulating smaller vesselsalong the path to reaching said vigorously bleeding area (likely due totrauma to a larger blood vessel). The TD may have smaller vesselhemostatic capabilities when energy is applied to lysing member. Havinga field of surgery with less bleeding may be beneficial to the surgeonwho is working to find and repair a larger blood vessel (for example, afemoral or brachial artery). The size of the TD's lysing areas may besuch that a larger vessel will not fit into the TD and thus not beaffected by the TD; thus, the surgeon may feel more confident that theTD will not risk traumatizing a larger blood vessel further.

In some implementations such as method 4300, the TD may also aid in thetreatment of hernias. Generally, herniated tissues are those that mayhave lost firmness and may have become lax allowing one or more organsto unwantedly protrude into adjacent spaces. To treat a hernia, surgeonsmay make paths to the site to be treated, may remove the lax hernia sacand/or other lax/herniated tissues by dissecting around said tissue(s),and may then connect/suture the edges of healthy tissue together tore-create the original healthy tissue wall, or, if insufficient healthytissue is present, may use mesh to connect the healthy tissue to formthe new tissue wall.

One implementation of a method 4300 according to this disclosure forrepairing hernias with the assistance of a TD is shown in FIG. 43 .

Step 4331 may comprise making a path to the site of the herniatedtissue. Step 4331 may also comprise using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught theherniated tissues and/or associated fibrous tissues and/or thesurrounding tissue(s). Step 4331 may be performed using, for example,needles, sutures, hooks, clamps, retractors, probes, bars, endoscopes,rakes, tubes, and/or TD.

Step 4332 may comprise dissecting around the herniated tissue in orderto remove it or free up adjacent structural tissue so that the TD oranother instrument may cut/excise around the herniated tissues forremoval. In some implementations step 4331 may be performed concurrentlywith step 4332. Step 4332 may further comprise passing the TD to atleast substantially free or prepare for excision the herniated tissuesand/or associated fibrous tissues from the surrounding tissues. In someimplementations, step 4332 may further comprise applying energy to thelysing members during this TD passage.

Step 4333 may comprise excising and removing the herniated/lax tissuesand/or hernia sac.

Step 4334 may comprise heating the tissue surrounding the herniatedtissue and/or associated fibrous tissues and/or tissue(s) that a surgeonintends to incorporate into the region to secure and/or restrain theremaining tissue into its intended and/or original place. In someimplementations, step 4334 may be performed using the TD, either withlysing segments of the TD or an energy window. Alternatively, the TD maybe withdrawn and a TMT may be introduced having an energy window andused for this purpose.

Step 4335 may comprise (if further freeing/excision appears necessary)using additional instrumentation to put force upon and/or pull and/orstretch and/or make taught target tissue(s) while the TD may be passedto more uniformly apply energy to the target tissue via the lysingmember(s) of the lysing tip and/or via the Tissue Modification Tip (TMT)or other applicable device that may induce hemostasis and/or inducepostoperative fibrosis, and/or alter certain tissues.

Step 4336 may comprise sewing, stapling or binding the remaining tissuesand/or herniated tissues into place. If insufficient healthy tissue ispresent to form a proper intended tissue wall, mesh may be used tobridge the space between the healthy tissues.

Step 4337 may comprise passing the TD adjacent to those tissues thathave been sewn and/or otherwise bound. In some implementations, step4337 may comprise activation of the lysing member or activation of a TMTto induce supportive fibrosis.

In some implementations, organs and/or organ systems that the TD may beuseful to assist in remedying a herniated state may include but notlimited to muscle, and/or parotid, and/or salivary gland, and/orgastrointestinal, and/or uterus, and/or bladder, and/or vascular, and/orgenitourinary.

One implementation of a method 4400 according to this disclosure foraccessing the central nervous system (CNS) with the assistance of a TDis shown in FIG. 44 . Although method 4400 is shown in the figurebeginning with step 4315, it should be understood that any of thepreliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 4400 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40 , steps4105-4115 of the method depicted in FIG. 41 , and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 44 .

After preparing the surgical field, making the entrance incision, andintroducing the TD through the entrance incision, step 4415 may comprisemaking a path to the target tissue/organ. More particularly, inimplementations accessing the brain, step 4415 may comprise moving theTD through the subgaleal layer; this may allow the scalp to be retractedfor better access to open the skull via bone saw and/or other toolsknown in the art. In some implementations step 4415 may further compriseactivating the lysing member to reduce bleeding from emissary bloodvessels. In implementations accessing the spinal cord, step 4415 maycomprise moving the TD through tissue surrounding the spine. In someimplementations, such movement may comprise a fanning motion. Step 4420may comprise dissecting the dura using the TD and/or identifyingimportant blood vessels, and/or other anatomy in the area surroundingthe target tissue. Step 4425 may comprise: adding additional fluids ofthe types previously described to the target and/or surrounding tissuesvia the TD port(s) or via one or more separate catheters or cannulas orendoscopes prior to and/or during the application of energy by TD. Step4429 may comprise: activating the energy to the TD for example theenergy to the lysing member(s). Step 4430 may further comprise passingthe TD around and/or through the target tissue in the CNS such as forexample, via a delicate fanning motion. In some implementations, the TDand/or the anticipated path may be visualized using for example anendoscope, a fiberoptic or camera, an RFID tag or other antenna. In someimplementations, such a device or devices may be positioned on the TD.In other implementations such a device or devices may be separate fromthe TD. Step 4435 may comprise: observing for bleeding from largervessels and achieving hemostasis as needed. In some implementationsachieving hemostasis may be accomplished by cautery, electrifying,ligating, chemical methods, and/or use of a TMT. In someimplementations, the lysing member(s) can be used to achieve thehemostasis. In some implementations, one or more other devices and/orsuture may be used to achieve hemostasis for larger vessels. Step 4440may comprise: removing the TD with power off and suturing the wound inthe standard fashion.

One implementation of a method 4500 according to this disclosure forremoving tissue from a peripheral nerve such as for example tumor and/orscar tissue and/or fibrosis with the assistance of a TD is shown in FIG.40 . Although method 4500 is shown in the figure beginning with step4531, it should be understood that any of the preliminary and latersteps described above in connection with other implementations and/ormethods and/or methods 4000, 4100, and 4200 may be performed in method4500 as well. For example, one or more of steps 4005-4035 in the methoddepicted in FIG. 40 may be performed in method 4500 if desired.Similarly, one or more other steps of any of the other implementationsdescribed herein such as for example, steps 4005-4045 of the methoddepicted in FIG. 40 may also be included in the method depicted in FIG.45 .

Step 4531 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the nerve and/ortissue adjacent a peripheral nerve (such as for example tumor and/orscar tissue and/or fibrosis) and/or surrounding tissue(s). Step 4531 maybe performed using, for example, needles, sutures, hooks, clamps,retractors, probes, bars, endoscopes, rakes, tubes, TD and/or by hand.In some implementations step 4531 may be performed concurrently withstep 4532. Step 4532 may comprise passing the TD to at leastsubstantially free the tumor(s) and/or scar tissue and/or fibrosis fromthe nerve and/or surrounding tissues. In some preferred implementations,step 4532 may comprise passing the TD to free, or at leastsubstantially, free, the tumor(s) and/or scar tissue from the nerveand/or surrounding tissues without activating the lysing segments of theTD. In other words, because of the sensitive nature of nerve tissue, itmay be preferred to use the TD as a blunt dissector without usingelectrosurgical energy. However, additional related steps may involveuse of such energy. In addition, in alternative implementations, energymay be applied to the lysing members during this TD passage. Step 4533may comprise identifying and/or testing the tissue (such as for exampletumor and/or scar tissue and/or fibrosis) to determine if it has beensufficiently freed from the nerve and/or surrounding tissues foruncomplicated removal. In some implementations endoscopes and/or bluntprobes and/or TD and/or surgeon's hands may be passed around the tumorand/or scar tissue and/or fibrosis to test the degree of freedom thetumor and/or scar tissue and/or fibrosis has from the nerve and/orsurrounding tissues. Step 4534 may comprise (if further freeing appearsnecessary) using additional instrumentation to put force upon and/orpull and/or stretch and/or make taught the nerve and/or tumor and/orscar tissue and/or fibrosis. Step 4535 may comprise passing the TD tofurther free the nerve; energy may be applied to the lysing membersduring this TD passage (in order to attempt hemostasis and/or inducepostoperative fibrosis). Step 4535 may be repeated as necessary untilthe tumor and/or scar tissue and/or fibrosis is sufficiently freed forremoval. In an implementation the TD is passed longitudinally along thenerve in a ‘stripping’ fashion, such that a longitudinal axis of the TDis at least substantially parallel to a longitudinal axis of the nerveduring step 4533. The shape of certain embodiments of lysing tipsdescribed herein may be particularly useful in allowing the tip to bemoved along a nerve without causing undue damage to the nerve. Moreparticularly, by providing smooth protrusions and recessing thesharpened or electro-cutting portions of the tip between theprotrusions, the nerve may be protected from the cutting aspects of thedevice.

In an alternative implementation of method 4500, this method may bemodified to allow for dissection of tissues to repair an aneurism. Insuch an implementation, each of the steps up to 4532 may besubstantially identical to method 4500. Step 4532 may instead comprisedissecting vascular and connective tissues in and around the aneurismusing the TD. This step may also include sealing small peripheralbleeders from and around the aorta. Step 4533 may comprisedissecting/cutting a section or sectioning the aorta with the TD.

In another alternative implementation of method 4500, this method may bemodified to conduct a coronary artery bypass graft and/or other vasculargraft. In such an implementation, each of the steps up to 4532 may besubstantially identical to method 4500. Step 4532 may instead comprisedissecting out the saphenous vein from a leg or other suitable vessel(e.g., infra mammary). Step 4533 may comprise dissecting along thevessel to remove any adhesions and/or seal/disconnect small peripheryblood vessels that may bleed and/or seal small peripheral vessels.

One implementation of a method 4600 according to this disclosure forcreating a tissue flap and/or section with the assistance of a TD isshown in FIG. 46 . (In this method 4600, the term ‘flap’ may include‘section’.) In some implementations, such a flap of tissue may be usedfor breast reconstruction. In some implementations, such a flap oftissue is a latissimus dorsi flap. In some implementations, such a flapof tissue is a TRAM (Transverse Rectus Abdominus Myocutaneous) flap.Although method 4600 is shown in the figure beginning with step 4631, itshould be understood that any of the preliminary and later stepsdescribed above in connection with other implementations and/or methodsand/or methods 4000, 4100, and 4200 may be performed in method 4600 aswell. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40 , steps 4105-4115 of the method depictedin FIG. 41 , and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 46 .

Step 4631 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the target region oftissue to be used in creating a tissue flap and/or the surroundingtissue(s). Step 4631 may be performed using, for example, needles,sutures, hooks, clamps, retractors, probes, bars, endoscopes, rakes,tubes, TD and/or by hand. In some implementations step 4631 may beperformed concurrently with step 4632. Step 4632 may comprise passingthe TD to at least substantially separate a sufficient amount of tissueto create and/or free at least a portion of the tissue flap. In someimplementations, step 4632 may further comprise applying energy to thelysing member(s) during this TD passage. Step 4633 may comprise testingthe target tissue flap to determine if it has been sufficiently freedfrom the surrounding tissues for uncomplicated removal (excluding itspedicle). In some implementations endoscopes and/or blunt probes and/orTD and/or surgeon's hands may be passed around the target organ/tissueto determine the degree of freedom a target flap and/or tissue has fromits surrounding tissues and/or organs. Step 4634 may comprise (iffurther freeing appears necessary) using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught the targetflap and/or tissue and/or other surrounding tissue while the TD may bepassed to further free the target flap and/or tissue; energy may beapplied to the lysing member(s) during this TD passage (in order toattempt hemostasis and/or induce postoperative fibrosis). Step 4635 maycomprise passing the TD (after the target flap and/or tissue has beenfreed and/or moved) to the tissues that were adjacent and remaining inthe body, which may aid the surgeon in examining for points of furtherbleeding and/or for further exploration; during such passage energy maybe applied to the lysing members (in order to attempt hemostasis and/orinduce postoperative fibrosis). In some implementations, traditionalinstruments may be used to achieve hemostasis. In some implementations,one or more of these steps using the TD may be performed with a fanningmotion. In implementations using TD's with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TD's with at least one nonaxially orientedprotrusion, such a fanning motion may comprise a side-to-side fanningmotion; one example of a fanning motion using a TD having at least onenonaxially oriented protrusion may comprise a ‘windshield wiper’ motion.In some implementations, the TD may be used to create flaps in and/orfrom tissues and/or organs including but not limited to muscle and/orfascia, and/or fibrous tissue and/or fat and/or vascular tissues. Insome implementations, the TD may be used to create flaps and/or sectionsin and/or from tissues and/or organs including but not limited to, lungand/or liver and/or gastrointestinal and/or genital/urinary and/oruterus and/or bladder.

One implementation of a method 4700 according to this disclosure forcreating a tissue graft with the assistance of a TD is shown in FIG. 47. In some implementations, such a graft of tissue may be used forreconstruction of traumatic wounds.

Although method 4700 is shown in the figure beginning with step 4731, itshould be understood that any of the preliminary and later stepsdescribed above in connection with other implementations and/or methodsand/or methods 4000, 4100, and 4200 may be performed in method 4700 aswell. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40 , steps 4105-4115 of the method depictedin FIG. 41 , and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 47 .

Step 4731 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the target region oftissue to be used in creating a tissue graft and/or the surroundingtissue(s). Step 4731 may be performed using, for example, needles,sutures, hooks, clamps, retractors, probes, bars, endoscopes, rakes,tubes, TD and/or by hand. In some implementations step 4731 may beperformed concurrently with step 4732. Step 4732 may comprise passingthe TD to at least substantially separate a sufficient amount of tissueto create and/or free at least a portion of the tissue graft. In someimplementations, step 4732 may further comprise applying energy to thelysing members during this TD passage. Step 4733 may comprise testingthe target tissue graft to determine if it has been sufficiently freedfrom the surrounding tissues for uncomplicated removal. In someimplementations endoscopes and/or blunt probes and/or TD and/orsurgeon's hands may be passed around the target organ/tissue todetermine the degree of freedom a target graft and/or tissue has fromits surrounding tissues and/or organs. Step 4734 may comprise (iffurther freeing appears necessary) using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught the targetgraft and/or tissue and/or other surrounding tissue while the TD may bepassed to further free the target graft and/or tissue; energy may beapplied to the lysing members during this TD passage (in order toattempt hemostasis and/or induce postoperative fibrosis). Step 4735 maycomprise passing the TD (after the target graft and/or tissue has beenfreed and/or moved) to the tissues that were adjacent and remaining inthe body, which may aid the surgeon in examining for points of furtherbleeding and/or for further exploration; during such passage energy maybe applied to the lysing members (in order to attempt hemostasis and/orinduce postoperative fibrosis). In some implementations, traditionalinstruments may be used to achieve hemostasis. In some implementations,one or more of these steps using the TD may be performed with a fanningmotion. In implementations using TD's with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TD's with at least one nonaxially orientedprotrusion, such a fanning motion may comprise a side-to-side fanningmotion; one example of a fanning motion using a TD having at least onenonaxially oriented protrusion may comprise a ‘windshield wiper’ motion.In some implementations, the TD may be used to create grafts in and/orfrom tissues and/or organs including but not limited to skin and/ormucosal and/or fascia, and/or connective/fibrous tissue (for example,tendon) and/or fat and/or vascular tissues. In some implementations, theTD may be used to create grafts in and/or from tissues and/or organsincluding but not limited to, lung and/or liver and/or gastrointestinaland/or genital/urinary and/or uterus and/or bladder. In someimplementations, the TD may be used to harvest any or all of theaforementioned tissues for organ culture.

One implementation of a method 4800 according to this disclosure forremoving tumor from an organ with the assistance of a TD is shown inFIG. 48 . In some implementations, the tumor may be incompletely removedto ‘debulk’ it and/or to prevent disease spread within the body and/orpathologic analysis. In some implementations, the tumor may becompletely removed to prevent disease spread within the body and/orpathologic analysis. Although method 4800 is shown in the figurebeginning with step 4831, it should be understood that any of thepreliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 4800 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40 , steps4105-4115 of the method depicted in FIG. 41 , and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 48 .

Step 4831 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the tumor and/or thesurrounding tissue(s). Step 4831 may be performed using, for example,needles, sutures, hooks, clamps, retractors, probes, bars, endoscopes,rakes, tubes, TD and/or by hand. In some implementations, step 4831 maybe performed concurrently with step 4832. Step 4832 may comprise passingthe TD to at least substantially free the tumor(s) from the surroundingtissues. In some implementations, step 4832 may further compriseapplying energy to the lysing segments and/or energy windows during thisTD passage. Step 4833 may comprise identifying and/or testing the tumorto determine if it has been sufficiently freed from the surroundingtissues and/or organ for uncomplicated removal. In some implementationsendoscopes and/or blunt probes and/or TD and/or surgeon's hands may bepassed around the tumor to test the degree of freedom the tumor has fromits surrounding tissues and/or organs. Step 4834 may comprise (iffurther freeing appears necessary) using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught the tumorand/or the surrounding tissue and/or organ while the TD may be passed tofurther free the tumor; energy may be applied to the lysing segmentsand/or energy windows during this TD passage (in order to attempthemostasis and/or induce postoperative fibrosis). In someimplementations, traditional instruments may be used to achievehemostasis. Step 4834 may be repeated as necessary until the tumor issufficiently freed for removal. Step 4835 may comprise passing the TD(after the tumor has been removed) to the tissues that were adjacent tothe tumor (and still remaining in the body), which may aid the surgeonin examining for points of further bleeding and/or for furtherexploration; during such TD passage, energy may be applied to the lysingsegments and/or energy windows. Step 4836 may comprise using the TD tosubdivide portions of the tumor which may aid in extracting the tumor inpieces if the surgery is done via a minimally invasive technique. Insome implementations, if the surgical incision in the body is larger,the tumor tissue may pass more freely out of the body without piecemealremoval. In some implementations, the tumor is placed in the appropriatemedium for a pathologist to examine or test. In some implementations,one or more of these steps using the TD may be performed with a fanningmotion. In implementations using TD's with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TD's with at least one nonaxially orientedprotrusion, such a fanning motion may comprise a side-to-side fanningmotion; one example of a fanning motion using a TD having at least onenonaxially oriented protrusion may comprise a ‘windshield wiper’ motion.In some implementations, organs and/or organ systems that the TD may beuseful to remove tumors which may include but not limited to skin,and/or muscle, and/or fibrous tissues, and/or parotid, and/or salivarygland, and/or thyroid, and/or lung, and/or breast, and/or heart, and/ornervous system, and/or spleen, and/or gastrointestinal, and/or liver,and/or pancreas, and/or gallbladder, and/or genital/urinary, and/orkidney, and/or adrenal, and/or prostate, and/or ovary, and/or uterus,and/or bladder, and/or vascular, and/or lymph nodes and/or skeleton,and/or central nervous system, and/or peripheral nervous system and/orlung.

One implementation of a method 4900 according to this disclosure forremoving an organ with the assistance of a TD is shown in FIG. 49 . Insome implementations, organ(s) may be removed from a donor to surgicallyimplant into a recipient patient. In some implementations, organ(s) maybe removed for disease and pathologic analysis. In some implementations,the donor may be the recipient patient (for example, a muscle graft).Although method 4900 is shown in the figure beginning with step 4931, itshould be understood that any of the preliminary and later stepsdescribed above in connection with other implementations and/or methodsand/or methods 4000, 4100, and 4200 may be performed in method 4900 aswell. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40 , steps 4105-4115 of the method depictedin FIG. 41 , and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 49 .

Step 4931 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the target tissueand/or organ(s) and/or the surrounding tissue(s). Step 4931 may beperformed using, for example, needles, sutures, hooks, clamps,retractors, probes, bars, endoscopes, rakes, tubes, TD and/or by hand.In some implementations, step 4931 may be performed concurrently withstep 4932. Step 4932 may comprise passing the TD to at leastsubstantially free the organ(s) from the surrounding tissues. In someimplementations, step 4932 may further comprise applying energy to thetissues during this TD passage. Step 4933 may comprise testing thetarget tissue and/or organ to determine if it has been sufficientlyfreed from the surrounding tissues for uncomplicated removal. In someimplementations endoscopes and/or blunt probes and/or TD may be passedaround the target organ/tissue to determine the degree of freedom atarget tissue and/or organ has from its surrounding tissues and/ororgans. Step 4934 may comprise (if further freeing appears necessary)using additional instrumentation to put force upon and/or pull and/orstretch and/or make taught the target tissue and/or organ and/or thesurrounding tissue while the TD may be passed to further free the targettissue and/or organ; energy may be applied during this TD passage. Step4935 may comprise passing the TD (after the target tissue and/or organhas been removed) to the tissues that were adjacent and remaining in thebody, which may aid the surgeon in examining for points of furtherbleeding and/or for further exploration; during such passage energy maybe applied to the lysing member(s) (in order to attempt hemostasisand/or induce postoperative fibrosis). In some implementations,traditional instruments may be used to achieve hemostasis. Step 4936 maycomprise clamping and/or sealing critical ducts and/or blood vessels onthe target tissue and/or organ so that the target tissue and/or organmay be properly transferred to and/or transported to and/or stored forthe recipient patient if it is a donor organ. In some implementations,an organ may be cooled or refrigerated. In other implementations if thetarget tissue and/or organ is diseased, the tissue may be properlyplaced in the appropriate medium for a pathologist to examine or test.In some implementations, one or more of these steps using the TD may beperformed with a fanning motion. In implementations using TD's withaxially oriented protrusions, such a fanning motion may comprise a toand fro spokewheel pattern. In implementations using TD's with at leastone nonaxially oriented protrusion, such a fanning motion may comprise aside-to-side fanning motion; one example of a fanning motion using a TDhaving at least one nonaxially oriented protrusion may comprise a‘windshield wiper’ motion. In some implementations, organs and/or organsystems that the TD may be useful to remove may include but not limitedto skin, and/or fibrous tissues, and/or muscle, and/or parotid, and/orsalivary gland, and/or thyroid, and/or breast, and/or lung, and/orheart, and/or gastrointestinal, and/or liver, and/or pancreas, and/orspleen, and/or gallbladder, and/or kidney, and/or adrenal, and/orprostate, and/or ovary, and/or uterus, and/or bladder, and/or vascular,and/or lymph nodes and/or skeleton, and/or central nervous system,and/or peripheral nervous system.

One implementation of a method 5000 according to this disclosure forremoving and/or freeing target scar tissue and/or fibrosis (or anotherfibrous tissue) from an organ with the assistance of a TD is shown inFIG. 50 . Although method 5000 is shown in the figure beginning withstep 5031, it should be understood that any of the preliminary and latersteps described above in connection with other implementations and/ormethods and/or methods 4000, 4100, and 4200 may be performed in method5000 as well. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40 , steps 4105-4115 of the method depictedin FIG. 41 , and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 50 .

Step 5031 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the scar tissueand/or fibrous tissue and/or the surrounding tissue(s). Step 5031 may beperformed using, for example, needles, sutures, hooks, clamps,retractors, probes, bars, endoscopes, rakes, tubes, TD and/or by hand.In some implementations step 5031 may be performed concurrently withstep 5032. Step 5032 may comprise passing the TD to at leastsubstantially free the scar tissue and/or other fibrous tissue from thesurrounding tissues. In some implementations, step 5032 may furthercomprise applying energy to the lysing member during this TD passage.Step 5033 may comprise identifying and/or testing the scar tissue and/orother fibrous tissue to determine if it has been sufficiently freed fromthe surrounding tissues and/or organ for uncomplicated removal. In someimplementations endoscopes and/or blunt probes and/or TD and/orsurgeon's hands may be passed around the scar tissue and/or otherfibrous tissue to test the degree of freedom the scar tissue and/orother fibrous tissue has from the surrounding tissues and/or organs (inorder to attempt hemostasis and/or modulate postoperative fibrosis).Step 5034 may comprise (if further freeing appears necessary) usingadditional instrumentation to put force upon and/or pull and/or stretchand/or make taught the scar tissue and/or other fibrous tissue and/orthe surrounding tissue and/or organ while the TD may be passed tofurther free the target scar tissue and/or other fibrous tissue; energymay be applied to the lysing member during this TD passage. Step 5034may be repeated as necessary until the target scar tissue and/or otherfibrous tissue is sufficiently freed and/or removed. Step 5035 maycomprise passing the TD (after the target scar tissue and/or fibrosishas been removed) to the tissues that were adjacent to the removedtissues (and still remaining in the body), which may aid the surgeon inexamining for points of further bleeding and/or for further exploration;during such TD passage, energy may be applied to the tissues via thelysing member(s) and/or the energy window(s). Step 5036 may compriseusing the TD to subdivide portions of the scar tissue and/or otherfibrous tissue which may aid in extracting the scar tissue and/or otherfibrous tissue in pieces if the surgery is done via a minimally invasivetechnique. In some implementations, if the surgical incision in the bodyis larger, the scar tissue and/or other fibrous tissue may pass morefreely out of the body without piecemeal removal. In someimplementations, one or more of these steps using the TD may beperformed with a fanning motion. In implementations using TD's withaxially oriented protrusions, such a fanning motion may comprise a toand fro spokewheel pattern. In implementations using TD's with at leastone nonaxially oriented protrusion, such a fanning motion may comprise aside-to-side fanning motion; one example of a fanning motion using a TDhaving at least one nonaxially oriented protrusion may comprise a‘windshield wiper’ motion. In some implementations, organs and/or organsystems that the TD may be useful to free and/or remove scar tissueand/or other fibrous tissue from may include but not limited to muscle,and/or parotid, and/or salivary gland, and/or thyroid, and/or lung,and/or heart (pericardial adhesions), and/or gastrointestinal(strictures), and/or liver, and/or pancreas, and/or spleen, and/orgallbladder (adhesions), and/or kidney, and/or adrenal, and/or prostate,and/or ovary, and/or uterus, and/or bladder, and/or vascular, and/orlymph nodes and/or skeleton, and/or central nervous system, and/orperipheral nervous system and/or lung (pleural adhesions) and/or fat(fibrous bands of cellulite). In some implementations, scarred and/orother fibrous tissue may bleed more than normal tissues when acted uponby a standard scalpel and/or surgical scissors; the TD may aid in suchscarred and/or fibrotic tissue removal as the TD may be able tocoagulate synchronously with both blunt and sharp dissectioncapabilities. The TD lysing member(s) may be able to contact more smallbleeding vessels (than a non-planar surgical device) due to TD's planargeometry and the chance that the geometry of the bleeding tissues may besubstantially planar.

An implementation of a method 5100 for incapacitating apocrine glands isshown in FIG. 51 . Although method 5100 is shown in the figure beginningwith step 5105, it should be understood that any of the preliminary andlater steps described above in connection with other implementationsand/or methods and/or methods 4000, 4100, and 4200 may be performed inmethod 5100 as well. For example, one or more other steps of any of theother implementations described herein such as for example, steps4005-4035 of the method depicted in FIG. 40 , steps 4105-4115 of themethod depicted in FIG. 41 , and steps 4205-4240 of the method depictedin FIG. 42 may also be included in the method depicted in FIG. 51 .

Step 5105 may comprise: having the surgical area cleaned by, forexample, isopropyl alcohol (degreaser) followed by germicidalchlorhexidine scrub. Step 5110 may comprise: applying a local anesthetic(such as injecting), such as about 1 cc of a 1% lidocaine+1:10,000adrenaline, to form about a wheal/hive on the periphery of the proposeddissection area on the axilla. Step 5115 may comprise, after allowingthe local anesthetic to settle, making an entrance incision and creatinga tip deployment pocket. The first sub-step of step 5115 may comprise,after allowing the local anesthetic to settle, performing a simple“stab” incision of the wheal, for example, a #15 Bard-Parker™ Scalpelinto the subcutaneous fat. This incision may be about 3 mm in length orless. The second sub-step of step 5115 may comprise creating a tipdeployment pocket that may receive the lysing tip; said pocket may bemade using a scalpel, scissors and/or wide array of instruments known inthe art to dissect tissue. The tip deployment pocket may be made byblunt dissection such as using a Metzenbaum scissors in a spreadingfashion and/or by sharp dissection using scalpel blade and/or scissorand/or energized dissection (for example, by laser and/orelectrosurgical needle and/or ultrasonic probe); bleeding points may becoagulated in the standard methods. In certain implementations, acomfortable size of the tip deployment pocket may be about 150% of thelength of the lysing tip with a comfortable range of 100% to 300% oflength of the lysing tip. For example, a 13 mm lysing tip may deploy tothe treatment configuration in a pocket of 2 cm squared or a circularpocket of 2 cm in diameter. In alternative implementations, the surgeonmay open an additional incision down the path closer to the treatmentzone.

Step 5120 may comprise: applying one or more fluids to the tissue. Insome implementations, the fluid(s) may comprise water. In someimplementations, the fluid(s) may comprise an ionic fluid, such as asaline solution. The fluid(s) may be applied to the tissue by, forexample, injection into the stab wound(s) and may comprise a fluid thatis both ionic and an anesthetic, such as a tumescent anesthesia. Someimplementations may comprise applying one or more fluids that serve asan ionic fluid, an anesthetic, and an adrenaline In some suchimplementations, the fluid(s) may comprise a Klein Formula, such asabout 1 cc-3 cc of Klein Formula (such as a 0.1% lidocaine+epinephrine1:1,000,000+NaHCO₃@5 meq/L of saline) per square centimeter ofanticipated dissection. This fluid(s) may be injected into the stabwounds via, for example, a 3 mm spatula cannula with syringe, and may befanned out to match the area to be dissected/undermined. In someimplementations, Tumescent Anesthesia (TA) may be allowed to settle forabout 10-30 minutes.

One or more fluids may alternatively, or additionally, be applied to thetissue by using the TD. For example, the TD may comprise one or morecanals for delivering fluids to the tissue (for example, canal 304depicted in FIG. 3 a ). In some embodiments, the canal(s) may beconfigured to deliver the fluid(s) adjacent to the lysing tip such asvia a port located adjacent to the internal device cannula and/or lysingtip. In some such embodiments, the canal(s) may be configured to deliverthe fluid(s) to the area around the lysing tip.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated as described in theprevious method 5100 for apocrine glands.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated by a applying acooling step antecedent and or concurrent to energy delivery with theTD. Such steps may comprise use of a cooling mechanism such as a coolingmechanism comprising a contact cooling object such as a cooling pad orbag. Such cooling mechanism may comprise for example, a closed water bagat a temperature of less than 37° C. In some implementations, the fluidor gel may range in temperature of between 1° C. to 20° C. In some suchimplementations, the fluid or gel may be about 15° C. Other coolingmechanisms may comprise a dynamic cooling system wherein a cool liquidand/or gel and/or gas is actively pumped into or though the contactcooling object. In other implementations, a thermoelectric or Peltiercooling mechanism may be applied to externally cool the skin. One ormore cooling fluids (which may include gasses and/or gels) mayalternatively, or additionally, be applied to the tissue by using theTD. For example, the TD may comprise one or more canals for deliveringfluids such as coolants to the tissue. In some embodiments, the canal(s)may be configured to deliver the fluid(s) adjacent to the lysing tipsuch as via a port located adjacent to the internal device cannulaand/or lysing tip.

Step 5130 may comprise: inserting TD into the incision and fanning instrokes sufficient to cover a target area of for example, about 60 sqcm.

Step 5135 may comprise applying energy to one or more portions of thedissected area, for example, to heat the tissue to a desired temperatureto cause a desired effect, for example, to alter sweat glands and/ornerves and/or the tissues surrounding said glands or nerves. In someimplementations, such energy may be applied through the lysing tip byactivating the electrosurgical generator's coagulation mode. Inalternative embodiments, the lysing tip may be replaced with a tissuemodifying tip (TMT) illustrated in FIGS. 32 and 33 which may beactivated with coagulation energy. In alternative implementations, asurgeon may choose another method to apply energy to tissues. Applyingcooling fluids and/or cooling methods during this step may bebeneficial.

Step 5137 may comprise: milking the dissected area to determine if anysignificant bleeding or drainage is present.

Step 5140 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

TD may be used in an implementation of a method 5200 for incapacitatingeccrine glands as shown in FIG. 52 . Although method 5200 is shown inthe figure beginning with step 5205, it should be understood that any ofthe preliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 5200 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40 , steps4105-4115 of the method depicted in FIG. 41 , and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 52 .

Step 5205 may comprise: having the surgical area cleaned by, forexample, isopropyl alcohol (degreaser) followed by germicidalchlorhexidine scrub. Step 5210 may comprise: applying a local anesthetic(such as injecting), such as about 1 cc of a 1% lidocaine+1:10,000adrenaline, to form a wheal/hive on the periphery of the proposeddissection area on the axilla. Step 5215 may comprise, after allowingthe local anesthetic to settle, making an entrance incision and creatinga tip deployment pocket. The first sub-step of step 5215 may comprise,after allowing the local anesthetic to settle, performing a simple“stab” incision of the wheal, for example, a #15 Bard-Parker™ Scalpelinto the subcutaneous fat. This incision may be about 3 mm in length orless. The second sub-step of step 5215 may comprise creating a tipdeployment pocket that may receive the lysing tip; said pocket may bemade using a scalpel, scissors and/or wide array of instruments known inthe art to dissect tissue. The tip deployment pocket may be made byblunt dissection such as using a Metzenbaum scissors in a spreadingfashion and/or by sharp dissection using scalpel blade and/or scissorand/or energized dissection (for example, by laser and/orelectrosurgical needle and/or ultrasonic probe); bleeding points may becoagulated in the standard methods. In certain implementations, acomfortable size of the tip deployment pocket may be about 150% of thelength of the lysing tip with a comfortable range of 100% to 300% oflength of the lysing tip. For example, a 13 mm lysing tip may deploy tothe treatment configuration in a pocket of 2 cm squared or a circularpocket of 2 cm in diameter.

Step 5220 may comprise: applying one or more fluids to the tissue. Insome implementations, the fluid(s) may comprise water. In someimplementations, the fluid(s) may comprise an ionic fluid, such as asaline solution. The fluid(s) may be applied to the tissue by, forexample, injection into the stab wound(s) and may comprise a fluid thatis both ionic and an anesthetic, such as a tumescent anesthesia. Someimplementations may comprise applying one or more fluids that serve asan ionic fluid, an anesthetic, and an adrenaline In some suchimplementations, the fluid(s) may comprise a Klein Formula, such asabout 1 cc-3 cc of Klein Formula (such as a 0.1% lidocaine+epinephrine1:1,000,000+NaHCO₃@5 meq/L of saline) per square centimeter ofanticipated dissection. This fluid(s) may be injected into the stabwounds via, for example, a 3 mm spatula cannula with syringe, and may befanned out to match the area to be dissected/undermined. In someimplementations, Tumescent Anesthesia (TA) may be allowed to settle forabout 10-30 minutes.

One or more fluids may alternatively, or additionally, be applied to thetissue by using syringes and/or other cannulas and/or tubing.Alternatively, the TD may comprise one or more canals for deliveringfluids to the tissue. In some embodiments, the canal(s) may beconfigured to deliver the fluid(s) adjacent to the lysing tip such asvia a port located adjacent to the internal device cannula and/or lysingtip. In some such embodiments, the canal(s) may be configured to deliverthe fluid(s) to the area around the lysing tip.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated as described in theprevious method 5000 for apocrine glands.

Step 5230 may comprise: inserting TD into the incision and fanning instrokes sufficient to cover a target area of for example, about 60 sqcm.

Step 5235 may comprise applying energy to one or more portions of thedissected area, for example, to heat the tissue to a desired temperatureto cause a desired effect, for example, to alter sweat glands and/ornerves and/or the tissues surrounding said glands or nerves. In someimplementations, such energy may be applied through the lysing tip byactivating the electrosurgical generator's coagulation mode. Inalternative embodiments, the lysing tip may be replaced with a tissuemodifying tip (TMT) illustrated in FIGS. 32 and 33 which may beactivated with coagulation energy. In alternative implementations, asurgeon may choose another method to apply energy to tissues. Applyingcooling fluids and/or cooling methods during this step may bebeneficial.

Step 5237 may comprise: milking the dissected area to determine if anysignificant bleeding or drainage is present.

Step 5240 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

TD may be used in one implementation of a method 5300 for incapacitatinghair follicles is shown in FIG. 53 . Although method 5300 is shown inthe figure beginning with step 5305, it should be understood that any ofthe preliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 5300 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40 , steps4105-4115 of the method depicted in FIG. 41 , and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 53 .

Step 5305 may comprise: having the surgical area cleaned by, forexample, isopropyl alcohol (degreaser) followed by germicidalchlorhexidine scrub. Step 5310 may comprise: applying a local anesthetic(such as injecting), such as about 1 cc of a 1% lidocaine+1:10,000adrenaline, to form about a wheal/hive on the periphery of the proposeddissection area.

Step 5315 may comprise, after allowing the local anesthetic to settle,making an entrance incision and creating a tip deployment pocket. Thefirst sub-step of step 5315 may comprise, after allowing the localanesthetic to settle, performing a simple “stab” incision of the wheal,for example, a #15 Bard-Parker™ Scalpel into the subcutaneous fat. Thisincision may be about 3 mm in length or less. The second sub-step ofstep 5315 may comprise creating a tip deployment pocket that may receivethe lysing tip; said pocket may be made using a scalpel, scissors and/orwide array of instruments known in the art to dissect tissue. The tipdeployment pocket may be made by blunt dissection such as using aMetzenbaum scissors in a spreading fashion and/or by sharp dissectionusing scalpel blade and/or scissor and/or energized dissection (forexample, by laser and/or electrosurgical needle and/or ultrasonicprobe); bleeding points may be coagulated in the standard methods. Incertain implementations, a comfortable size of the tip deployment pocketmay be about 150% of the length of the lysing tip with a comfortablerange of 100% to 300% of length of the lysing tip. For example, a 13 mmlysing tip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. In alternativeimplementations, the surgeon may open an additional incision down thepath closer to the treatment zone.

Step 5320 may comprise: applying one or more fluids to the tissue. Insome implementations, the fluid(s) may comprise water. In someimplementations, the fluid(s) may comprise an ionic fluid, such as asaline solution. The fluid(s) may be applied to the tissue by, forexample, injection into the stab wound(s) and may comprise a fluid thatis both ionic and an anesthetic, such as a tumescent anesthesia. Someimplementations may comprise applying one or more fluids that serve asan ionic fluid, an anesthetic, and an adrenaline In some suchimplementations, the fluid(s) may comprise a Klein Formula, such asabout 1 cc-3 cc of Klein Formula (such as a 0.1% lidocaine+epinephrine1:1,000,000+NaHCO₃@5 meq/L of saline) per square centimeter ofanticipated dissection. This fluid(s) may be injected into the stabwounds via, for example, a 3 mm spatula cannula with syringe, and may befanned out to match the area to be dissected/undermined. In someimplementations, Tumescent Anesthesia (TA) may be allowed to settle forabout 10-30 minutes.

One or more fluids may alternatively, or additionally, be applied to thetissue by using the TD. For example, the TD may comprise one or morecanals for delivering fluids to the tissue. In some embodiments, thecanal(s) may be configured to deliver the fluid(s) adjacent to thelysing tip such as via a port located adjacent to the internal devicecannula and/or lysing tip. In some such embodiments, the canal(s) may beconfigured to deliver the fluid(s) to the area around the lysing tip.Alternatively, or additionally, the fluid(s) may be delivered elsewhereon the tip or elsewhere on the shaft of the TD.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated as described in theprevious method 5000 for apocrine glands.

Step 5330 may comprise: inserting TD into the incision and fanning instrokes sufficient to cover an area of for example, about 60 sqcm.

Step 5335 may comprise applying energy to one or more portions of thedissected area, for example, to heat the tissue to a desired temperatureto cause a desired effect, for example, to alter hair follicles and/orthe tissues surrounding said follicles. In some implementations, suchenergy may be applied through the lysing tip by activating theelectrosurgical generator's coagulation mode. In alternativeembodiments, the lysing tip may be replaced with a tissue modifying tip(TMT) illustrated in FIGS. 32 and 33 which may be activated withcoagulation energy. In alternative implementations, a surgeon may chooseanother method to apply energy to tissues. Applying cooling fluidsand/or cooling methods during this step may be beneficial.

Step 5337 may comprise: milking the dissected area to determine if anysignificant bleeding or drainage is present.

Step 5340 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

In one implementation, TD may be used for the treatment of cellulite,such as cellulite treatment zones 5401 and 5402 as shown in FIG. 54 .Said implementation may comprise a method 5500 of steps listed in FIG.55 . A more particular example of such an implementation is furtherillustrated in FIG. 54 . It should be understood that any of the stepsdescribed above in connection with other implementations and/or methods4000, 4100, and 4200 may be performed in methods 5500 as well. Forexample, one or more other steps of any of the other implementationsdescribed herein such as for example, steps 4005-4035 of the methoddepicted in FIG. 40 , steps 4105-4115 of the method depicted in FIG. 41, and steps 4205-4240 of the method depicted in FIG. 42 may also beincluded in the method depicted in FIG. 55 .

Step 5505 comprises making an entrance incision. In some implementationsstep 5505 may comprises making a stab incision 5410 in a location thatis not usually visible to the eye, for example, the bikini line. In someimplementations the incision may be of sufficient length to receive thelysing tip and/or cannula in an axial/delivery configuration.Preferably, the length of the incision is no greater than as necessaryto receive the lysing tip and/or cannula. Preferably, the length of theincision is smaller than the length of the lysing tip in its treatmentconfiguration. In some implementations, the length of the incision maybe between about 2 mm and 12 mm.

Step 5510 may comprise forming a tip deployment pocket 5411 a forreceipt and/or reconfiguring of the lysing tip from its deliveryconfiguration to its treatment configuration. In some implementations,curved blunt scissors may be used to make this tip deployment pocket byfor example inserting said scissors up to its pivot point and/oropening/closing the scissors. In some implementations, the tipdeployment pocket may be approximately the size of half of a postagestamp. For example, the tip deployment pocket may have a width in thedirection of the incision of about 1 cm. Similarly, the tip deploymentpocket may have a length perpendicular to the width of between about 1cm to 2 cm. The dissection plane of the pocket is preferably in the sameplane of dissection of the path to the treatment zone and/or thetreatment zone. However, it is contemplated that in an alternativeimplementation a surgeon may use the TD to move from the plane of thepocket into another tissue plane. Preferably, the width of the tipdeployment pocket is larger than the length of the incision to, forexample, minimize scarring but create an area large enough toaccommodate the lysing tip being deployed to its treatmentconfiguration. Preferably, the width of the tip deployment pocket isapproximately equal to or slightly larger than the length of the lysingtip. In some implementations, the proximal edge of the tip deploymentpocket defining the width of the pocket may be coincident with orpositioned slightly distal of the incision line as shown in FIG. 54 a .The tip deployment pocket may be made using a scalpel, scissors, and/orwide array of instruments known in the art to dissect tissue. In certainimplementations, a comfortable size of the tip deployment pocket may beabout 150% of the length of the lysing tip with a comfortable range of100% to 300% of length of the lysing tip. For example, a 13 mm lysingtip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. In alternativeimplementations, the surgeon may open an additional incision down thepath closer to the treatment zone.

Step 5515 may comprise inserting the TD through the incision anddeploying/securing the lysing tip. In some implementations, the TD maybe deployed through a cannula and once within the tip deployment pocketmay be reconfigured from its delivery configuration to its treatmentconfiguration. In other implementations, the lysing tip and/orgrasping/control means may be inserted through the incision to the tipdeployment pocket in which the lysing tip and grasping/control means maybe coupled together in the treatment configuration. For example, thelysing tip may be grasped in an axial configuration such as along one ofthe sides of the grasping pad 718 as shown in FIG. 7 e . The lysing tipmay then be released and rotated manually, such as by palpation, afterwhich the lysing tip may be grasped in the treatment configuration withthe elongated length of the lysing tip perpendicular or at leastsubstantially perpendicular to the axis of the grasping/control. means.

In some implementations in which the lysing tip, either lysing tip 710or any of the other free floating lysing tips disclosed herein, aremanually inserted, a surgeon may insert the lysing tip through anentrance incision such that the longest axis of the lysing tip(typically the axis between the two outer protrusions and/or beads) isparallel or at least substantially parallel to the direction ofinsertion. Once the lysing tip has been inserted through the entranceincision, the lysing tip may be manually rotated such as by palpation,or by use of the control/grasping instrument, or an external device suchas a hemostat or another suitable instrument. In some suchimplementations, a tip deployment pocket may be created before insertionof the lysing tip as discussed below. This tip deployment pocket mayfacilitate rotation of the lysing tip and/or may allow for coupling ofthe lysing tip with a suitable instrument for delivering electrosurgicalenergy and/or controlling the lysing tip during a surgical procedure.

Step 5516 may comprise having in place and utilizing an infrared and/orheat detecting camera 13 (e.g., FLIR®) connected by wire or wirelessly(for example via antennae 47 a) to a central processing unit 14 andoutput video monitor 15; the camera data may be combined with data inputthat may be generated by signals originating from RFID chips and/orantennae 47 with further data that may originate from sensors 48 thatmay be located on or near lysing tips or TMTs (lysing tip and controlgrasping instrument system 16 are depicted in FIG. 54 a with antennae 47and sensor 48 mounted on grasping control instrument shaft). In someembodiments, sensor 48 may be a thermistor. Infrared camera imagesoverlying sensor outputs and location outputs on the video screen mayaid the surgeon in determining the proper speed of the tip and/orsettings and/or dwelling time. One or more of these steps involving useof an infrared camera may be applied to other ski-related methodsdisclosed herein such as those related to treatment of apocrine andeccrine sweating, incapacitation of hair follicles, treatment ofcellulite, wrinkles, lines, folds, and other defects, as well asrejuvenational treatments for the face, neck, and brow/scalp.

Step 5520 may comprise forming one or more paths 5412 a/5412 b to one ormore treatment zones 5401 and/or 5402 respectively. In someimplementations, a fifth step may comprise activating one or more lysingmembers and then advancing the lysing tip towards the treatment zone.This may be done for example in a series of substeps by advancing thelysing tip and pulling it back in a repeated fashion similar to abattering ram. The surgeon may create additional paths adjacent to theinitial path, thus creating a triangular and/or cone shape between theincision and the treatment zone. In alternative implementations, whereinthe surgeon may prefer to minimize the amount of energy deposited alongthe path to the target tissue/cellulite treatment zone, especially whileusing lysing tips of 3 protrusions or less, the lysing tip may berotated with the lysing rod axis perpendicular to the plane of the skinto create the path. Rotating the lysing rod axis perpendicular may allowthe tip to migrate in between the vertically oriented fibrous bandsbetween the dermis and the lower/deeper tissues. As shown in FIG. 54 a ,if the treatment zone 5401 has a width wider than the width of the path,the surgeon may, either right before or simultaneously with movement ofthe tip into the treatment zone, manipulate the treatment zone, such asby traction (either manual or using instrumentation), into the path ofthe lysing tip. For example, as indicated by arrow 5415, initially a topportion of the treatment zone may be forced downward into the path ofthe lysing tip. The lysing tip may then be used to treat the top portionof the treatment zone. Subsequently, a bottom portion of the treatmentzone may then be manipulated in the direction of arrow 5416 into thepath of the lysing tip and the lysing tip may then be used to treat thebottom portion of the treatment zone. In some implementations, thelysing tip will extend beyond the boundaries of the treatment zone 5401;this “feathering” beyond the boundaries into more normal tissues mayensure full treatment of the condition. This step may be repeated totreat all of the various treatment zones such as 5402. Preferably, pathsto each of the various treatment zones (for example, 5412 b) may comefrom the same incision 5410 and tip deployment pocket 5411.

In an alternative implementation depicted in FIG. 54 b , the tipdeployment pocket 5411 b may be more adjacent to the treatment zone5401. In some such implementations the tip deployment pocket 5411 b maybe formed during the course of repositioning the lysing tip between itsdelivery and treatment configurations. For example, the proximal portionof the path 5413 may be formed by advancing the cannula and/or lysingtip from the incision in the delivery configuration after which thelysing members may be activated and the lysing tip rotated or otherwiserepositioned from the delivery to the treatment configurations therebyforming a tip delivery pocket for delivery of the lysing tip to thetreatment zone.

Step 5525 may comprise, after lysing the tissues in the treatment zone,applying energy to the treatment zone. In some implementations,energizing the lysing member(s) with a cut and/or coagulation and/orblend between cut and coagulation energy waveforms may accomplish adesired treatment, for example, heating/denaturing the subcutaneousadipose tissues which may result in their reduction and/or heating thesubdermal tissue layers to cause a skin tightening effect. In otherimplementations, to apply energy to the treatment zone(s), the lysingtip may be withdrawn from the incision and another energy depositiondevice and/or a TMT (Tissue Modification Tip) may be energized todeposit energy in the treatment zone(s) for an intended effect. The TMTmay be passed to or through the treatment zone with the energy windowfacing upwards towards the subdermal layers. Possible results ofpointing upwards may include alteration of the collagen in that areayielding overlying skin tightening. In some implementations, the TMT maybe turned upside down with the energy window directed at thesubcutaneous adipose tissue layer and energized during at least part ofthe procedure. Possible results of this may include the alterationand/or damaging and/or death of some adipose cells that stimulate aninflammatory response in the subcutaneous adipose tissues that maytransfer to the subdermal and/or dermal layers via cells and/orchemical/biological mediators thus possibly resulting in the alterationof tissue thickness and/or tissue tightening in tissues that had notbeen directly damaged/modified by the lysing tip and/or TMT.

In some implementations, a surgeon may reduce bleeding by use of suchinstruments as a bovie probe and/or grasper/clamp. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and fatmodification. In such implementations, the energy window of the TMT maybe configured to deliver the following types of energy modalitiesincluding but not limited to laser, intense pulse light, resistiveheating, radiant heat, thermochromic, ultrasound, and/or microwave.

Step 5530 may comprise rotating and/or reconfiguring the lysing tip backinto the delivery configuration in either the treatment area and/or thetip deployment pocket and/or the path, if it is sufficiently wide, andwithdrawing the lysing tip and/or cannula back through the incision.

An example of a method 5600 for face dissection and/or face liftingaccording to some implementations will now be described as illustratedin FIG. 56 .

Step 5605 may comprise, after allowing the local anesthetic to settle,making and/or extending and/or using an existing entrance incision atthe front/bottom/rear of the ear and creating a tip deployment pocket.However, incisions with endoscopic and/or laparoscopic instrumentsshould not be limited to this area as cosmetic surgeons may prefer toplace incisions at anatomical boundaries and/or natural crease areas. Infurther contemplated embodiments, intra-oral, intra-nasal, and routes ofinstrument passage through the inner eyelids may be used for deviceand/or tip delivery. For example, an incision may be made where the noseand lip meet the cheek. An incision may be made in the skin in such aselected area so as to introduce a laparoscopic/endoscopic instrument,scissors, and/or scalpel to create a tip deployment pocket adjacent theincision if desired. The first sub-step of step 5605 may comprise, afterallowing the local anesthetic to settle, performing a simple “stab”incision of the wheal, for example, a #15 Bard-Parker™ Scalpel into thesubcutaneous fat. This incision may be about 3 mm in length or less. Thesecond sub-step of step 5605 may comprise creating a tip deploymentpocket that may receive the lysing tip which may be positioned at thedistal end of the device, which pocket may be made/enlarged with ascalpel, any laparoscopic instrument with or without electrosurgicalcurrent applied to it, an ultrasonic surgical device and/ormicrowave-powered instrument and/or laparoscopic scissors, and/orthermochromic media, electromagnetically energized instrument, and/orthermally energized instrument, and/or scissor tips, and/or knife tips.The tip deployment pocket may be made by blunt dissection such as usinga Metzenbaum scissors in a spreading fashion and/or by sharp dissectionusing scalpel blade and/or scissor and/or energized dissection (forexample, by laser and/or electrosurgical needle and/or ultrasonicprobe); bleeding points may be coagulated in the standard methods. Incertain implementations, a comfortable size of the tip deployment pocketmay be about 150% of the length of the lysing tip with a comfortablerange of 100% to 300% of length of the lysing tip. For example, a 13 mmlysing tip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. The tip deploymentpocket may or may not be the desired tissue layer of the dissectionand/or the final dissection as various blends of dissection planes maybe used by certain surgeons to achieve desired face lifting. However, acomfortable plane in which to create a tip deployment pocket wouldlikely be the upper subcutaneous plane in the preauricular region. Tipdeployment pockets may be created in other locations using endoscopicinstruments farther along the planned path of dissection and/or viaseparate stab incision further along the path of dissection. Theinstrument that made the tip deployment pocket is then removed.Depending upon the quality of the tissue in the tip deployment pocketadjacent the entrance incision, the lysing tip of the TD may be used toform the tip deployment pocket by energizing the lysing members of thelysing tip while rotating the lysing tip from the delivery configurationto the treatment configuration.

Step 5610 may comprise inserting the TD through the incision into thetip deployment pocket for receipt and/or reconfiguring of the lysing tipfrom its delivery configuration to its treatment configuration.

In some implementations, the TD may be deployed through a cannula andonce within the tip deployment pocket may be reconfigured from itsdelivery configuration to its treatment configuration. In otherimplementations, the lysing tip and/or grasping/control means may beinserted through the incision to the tip deployment pocket in which thelysing tip and grasping/control means may be coupled together in thetreatment configuration. For example, the lysing tip may be grasped inan axial configuration such as along one of the sides of the graspingpad 718 as shown in FIG. 7 e prior to inserting the TD in the incision.The lysing tip may then be inserted in the incision and released. Thenthe lysing tip may be rotated; if necessary, manual rotation may beimplemented (for example, by palpation) after which the lysing tip maybe grasped in the treatment configuration with the elongated length ofthe lysing tip perpendicular or at least substantially perpendicular tothe axis of the grasping/control means.

Step 5615 may comprise making paths with the TD. In someimplementations, after activating the TD, the surgeon may advance thetip a certain distance, for example, 2 cm. The tip may then be pulledback (with or without electrosurgical energy), in some cases to the tipdeployment pocket, and dissection may then proceed along the same pathor along an immediately adjacent path. It may be convenient for thesurgeon to only partially overlap advancing strokes especially in moredense tissue. It may also be beneficial not to use energy on thewithdrawal (non-forward) portion of the strokes. A possible example ofonly partially overlapping advancing strokes is, if the device is fourbulbs wide (the initial path should be about four bulbs wide); a newadjacent path may be lysed with two bulbs in the new adjacent path andtwo bulbs in the previously dissected path. The device tip may then bepulled back, in some cases to the tip deployment pocket, and advanced onthe other adjacent path immediately adjacent to the original dissectionpath with two bulbs in the new adjacent path and two bulbs in theoriginal dissection path. If using the four bulb device example, thewidth of the original dissection would be four bulbs. Then theadditional adjacent dissection paths would be two plus two bulbs inwidth resulting in an overall two plus two plus two equal six bulb widthpath after three forward strokes. The device path may be lengthened insegments in a similar fashion. The device path width may be increased insegments in a similar fashion.

The dissection may be increased segmentally until it occupies the entirearea the surgeon desires to dissect at the appropriate depth or plane(s)of choice of the surgeon. Other endoscopic instruments may be used toobserve and/or maintain the plane and/or address bleeding blood vesselsand/or tissues. Upon completion of the desired dissection, within anypoint of the dissection with sufficient area, the lysing tip may berotated from the treatment configuration to the delivery configurationand withdrawn through the entrance incision.

Step 5620 may comprise subjecting some or all exposed tissue(s) toadditional energy via a lysing tip or a separate TMT. In someimplementations, after dissection in segments and/or the totaldissection, one or more additional types of energy may be applied to theinner and/or outer layers of the dissection plane. The lysing member ofthe TD and/or the energy window of the TMT may be directed at thesubcutaneous adipose tissue layer and energized. Possible results ofthis may include the alteration and/or damaging and/or death of someadipose cells that stimulate an inflammatory response in thesubcutaneous adipose tissues that may transfer to the subdermal and/ordermal layers via cells and/or chemical/biological mediators thuspossibly resulting in the alternation of tissue thickness and/or tissuetightening in tissues that had not been directly damaged/modified by thelysing tip and/or TMT. In other implementations, energy applied to theinner layer of the dissection plane may alter and/or damage othertissues including fibrous tissues wherein the results of damaging saidtissues may release mediators and/or products of damage such as charreddebris which may also stimulate an inflammatory and/or immunologicresponse that may cause tissue contraction and/or fibrosis in that layerof the dissection plane and/or in an adjacent layer. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and fatmodification.

In some implementations, a surgeon may reduce bleeding by use of suchinstruments as a bovie probe and/or graspers or clamps and/or graspingand/or clamp-like instruments. In some implementations, a deviceutilizing ultrasonic vibration to cut and cauterize tissue such as aharmonic scalpel may be used to reduce bleeding. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and/orfatty tissue modification. In such implementations, the energy window ofthe TMT may be configured to deliver the following types of energy:electrosurgical, ultrasound, intense pulse light, laser, radiant heat,thermochromic, and/or microwave. In such implementations, the energywindow of the TMT may be configured to deliver the following types ofenergy modalities including, but not limited to, laser, intense pulselight, resistive heating, radiant heat, thermochromic, ultrasound,mechanical, and/or microwave.

Step 5623 may comprise: lightly milking the dissected area to determineif any significant bleeding or drainage is present.

Step 5624 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

Step 5625 may comprise post-operative care. Some post-operativedressings may be appropriate to reduce the incidence of seromas and/orhematomas. Appropriate dressings may include some with pressurecharacteristics. Incisions may be dealt with by methods that may includesuturing and/or stapling and/or tissue gluing and/or taping, forexample, with Steri-strips® and/or other methods that the surgeon maydesire.

An example of a method 5700 for neck dissection and/or neck liftingaccording to some implementations will now be described as illustratedin FIG. 57 . This method may be performed by itself or with otherprocedures including method 5600.

Step 5705 may comprise, after allowing the local anesthetic to settle,making and/or extending and/or using an existing entrance incision andcreating a tip deployment pocket. In some implementations, the neckdissection may be carried out by extending the lower portion of the facelift dissection or separately as its own procedure. Therefore, neckdissection entrance wounds may be located in the submental crease areaand/or around the chin. Other entrance areas may also include thosearound the ear. However, incisions with endoscopic and/or laparoscopicinstruments should not be limited to this area as cosmetic surgeons mayprefer to place incisions at anatomical boundaries and/or natural creaseareas. The first sub-step of step 5705 may comprise, after allowing thelocal anesthetic to settle, performing a simple “stab” incision of thewheal, for example, a #15 Bard-Parker™ Scalpel into the subcutaneousfat. This incision may be about 3 mm in length or less. The secondsub-step of step 5705 may comprise creating a tip deployment pocket thatmay receive the lysing tip at the distal end of the device; the tipdeployment pocket may be made using a scalpel, scissors, and/or widearray of instruments known in the art to dissect tissue. The tipdeployment pocket may be made by blunt dissection such as using aMetzenbaum scissors in a spreading fashion and/or by sharp dissectionusing scalpel blade and/or scissor and/or energized dissection (forexample, by laser and/or electrosurgical needle and/or ultrasonicprobe); bleeding points may be coagulated in the standard methods. Incertain implementations, a comfortable size of the tip deployment pocketmay be about 150% of the length of the lysing tip with a comfortablerange of 100% to 300% of length of the lysing tip. For example, a 13 mmlysing tip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. The tip deploymentpocket may or may not be the desired tissue layer of the dissectionand/or the final dissection as various blends of dissection planes maybe used by certain surgeons to achieve desired neck lifting. However, acomfortable plane in which to create a tip deployment pocket may be theupper subcutaneous plane in the preauricular region. Tip deploymentpockets may be created in other locations using laparoscopic/endoscopicinstruments farther along the planned path of dissection and/or viaseparate stab incision further along the path of dissection. Theinstrument that made the tip deployment pocket may then be removed.Depending upon the quality of the tissue in the tip deployment pocketadjacent the entrance incision, the lysing tip of the TD may be used toform the tip deployment pocket by energizing the lysing members of thelysing tip while rotating the lysing tip from the delivery configurationto the treatment configuration.

Step 5710 may comprise forming a tip deployment pocket for receiptand/or reconfiguring of the lysing tip from its delivery configurationto its treatment

Step 5715 may comprise making paths with the TD. In someimplementations, after activating the TD, the surgeon may advance thetip a certain distance, for example, 2 cm. The tip may then be pulledback (with or without electrosurgical energy), in some cases to the tipdeployment pocket, and dissection may then proceed along the same pathor along an immediately adjacent path. It may be beneficial to reducethe amount of potential tissue damaging energy to use energy onadvancing strokes of the TD and not using energy on the withdrawal(non-forward) portion of the strokes. For example, if the device is fourbulbs wide, that is the width of the initial path. The new adjacent pathmay be lysed with two bulbs in the new adjacent path and two bulbs inthe previously dissected path. The device tip may then be pulled back,in some cases to the tip deployment pocket, and advanced on the otheradjacent path immediately adjacent to the original dissection path withtwo bulbs in the new adjacent path and two bulbs in the originaldissection path. If using the four bulb device example, the width of theoriginal dissection would be four bulbs. Then the additional adjacentdissection paths would be two plus two bulbs in width resulting in anoverall two plus two plus two equal six bulb width path after threeforward strokes. The device path may be lengthened in segments in asimilar fashion. The device path width may be increased in segments in asimilar fashion.

The dissection may be increased segmentally until it occupies the entirearea the surgeon desires to dissect at the appropriate depth or plane(s)of choice of the surgeon. Other endoscopic instruments may be used toobserve and/or maintain the plane and/or address bleeding blood vesselsand/or tissues. Upon completion of the desired dissection, within anypoint of the dissection with sufficient area, the lysing tip may berotated from the treatment configuration to the delivery configurationand withdrawn through the entrance incision.

Step 5620 may comprise subjecting some or all exposed tissue(s) toadditional energy via a lysing tip and/or a separate TMT. In someimplementations, after dissection in segments and/or the totaldissection, one or more additional types of energy may be applied to theinner and/or outer layers of the dissection plane. The lysing member ofthe TD and/or the energy window of the TMT may be directed at thesubcutaneous adipose tissue layer and energized. Possible results ofthis may include the alteration and/or damaging and/or death of someadipose cells that stimulate an inflammatory response in thesubcutaneous adipose tissues that may transfer to the subdermal and/ordermal layers via cells and/or chemical/biological mediators thuspossibly resulting in the alternation of tissue thickness and/or tissuetightening in tissues that had not been directly damaged/modified by thelysing tip and/or TMT. In other implementations, energy applied to theinner layer of the dissection plane may alter and/or damage othertissues including fibrous tissues wherein the results of damaging saidtissues may release mediators and/or products of damage such as charreddebris which may also stimulate an inflammatory and/or immunologicresponse that may cause tissue contraction/tightening and/or fibrosis inthat layer of the dissection plane and/or in an adjacent layer.

Step 5623 may comprise lightly milking the dissected area to determineif any significant bleeding or drainage is present.

Step 5624 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

Step 5625 may comprise, after the neck has been dissected, addressingsuch other concerns as platysmal banding and/or prolapsed tissues suchas salivary glands using sutures and/or meshes and/or otherlaparoscopic/endoscopic tools as known in the art. In someimplementations, a surgeon may reduce bleeding by use of suchinstruments as a bovie probe and/or graspers or clamps and/or graspingand/or clamp-like instruments. In some implementations, a deviceutilizing ultrasonic vibration to cut and cauterize tissue such as aharmonic scalpel may be used to reduce bleeding. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and/orfatty tissue modification. In such implementations, the energy window ofthe TMT may be configured to deliver the following types of energy:electrosurgical, ultrasound, intense pulse light, laser, radiant heat,thermochromic, and/or microwave.

Step 5630 may comprise post-operative care. Some post-operativedressings may be appropriate to reduce the incidence of seromas and/orhematomas. Appropriate dressings may include some with pressurecharacteristics. Incisions may be dealt with by methods that may includesuturing and/or stapling and/or tissue gluing and/or taping, forexample, with Steri-strips® and/or other methods that the surgeon maydesire.

The TD may be used to treat various skin wrinkles, lines, folds andother visible defects. In an implementation, dissecting with the TDthrough, or around the platysma muscle in the neck in areas of lines orwrinkles may alter the attachments of the platysma to overlying oradjacent skin and thus diminish the visible assessment of surfacedefects.

In an alternative implementation, dissecting and/or energizing with theTD through or around the muscles of facial expression located in thesuperior nose, glabellar region, and/or adjacent tissues, for example,the procerus muscle, depressor supercilii muscle, and corrugatorsupercilii muscle may damage, denature, fibrose, alter, denervate and/ordisconnect the muscles and their action from the overlying or adjacentskin thus reducing the frown wrinkles or folds around the superior nose.

In some implementations, the surface skin effects of other muscles offacial expression may be altered by dissecting the tissues which may beattached between those muscles and the surface skin, no matter howloosely or indirect, using the TD. For example, some muscles of facialexpression around the mouth contribute to the formation of the nasallabial fold which gives may give an aging appearance depending upon itsdepth, acuteness, and/or shadow effect. Disinserting the surface skin inthe area from the underlying or adjacent tissues by dissecting with theTD may diminish the visibility of these folds. The entrance incision forthe TD to approach or reach the nasal labial fold may be anywhere on theface or head as well as inside the mouth or nose.

In another implementation, dissection with the TD may be used todiminish forehead wrinkles wherein the dissection and/or energy maydamage, denature, fibrose, alter, denervate and/or disconnect themuscles and their action from the overlying or adjacent skin thusreducing the brow and/or forehead wrinkling.

In another implementation, the wrinkles around the lower and outereyelids may be altered by dissecting between the orbicularis oculimuscle and the skin wherein a sheet of fibrous tissue may be laid downfollowing dissection and/or energy which may have a less foldablecharacter than the previously soft and pliable tissues. The entranceincision for the TD to approach the eyelid may be inside the lowereyelid through the conjunctiva and/or in a wrinkle of the face or lowereyelid.

Steps: everything for creating a path except can enter from inside noseor mouth or eye for areas mentioned above. Likely 2 bulb unit used.Since wrinkle or fold, dissection will be along the length of or aroundthe fold, not perpendicular to it. May be with or without energy. Mayuse TMT after dissection is complete; may point up or down. May be usedin conjunction with an implant, even an injectable, solid, semi-solidimplant. Finally, withdraw and sew.

An example of a method 5800 for brow and/or scalp dissection and/or browlifting according to some implementations will now be described asillustrated in FIG. 58 . Step 5805 may comprise making a sufficientnumber of incisions at the back of neck near or at the hairline and/orforehead/frontal hairline that permits sufficient passage of TD forintended effect. In other implementations, incisions may be madeanywhere within the scalp region. Step 5810 may comprise creating thetip deployment pocket as disclosed herein. Step 5810 may compriseforming a tip deployment pocket for receipt and/or reconfiguring of thelysing tip from its delivery configuration to its treatment. Step 5815may comprise dissecting the subgaleal plane with TD and may comprisefanning in the subgaleal plane, for example, in a spokewheel pattern, tothe extent desired by the surgeon. Step 5820 may comprise reconfiguringthe TD from the treatment configuration to the delivery configurationand/or removal through the entrance incision. Step 5825 may comprise,after desired tissue plane separation, rotating the dissected scalp into the desired position, for example, backward toward neck. Step 5830may comprise applying a fixation mechanism, for example, screws.

An example of a method 5900 for creation of pockets for implants,including, but not limited to, cosmetic implants, medical device andidentification implants is described. An implant may be defined hereinas any material surgically deposited and left in a patient/recipient'sbody that was not manufactured by the recipient's body. The TD may beuseful because it may expeditiously create said paths and said pocketswith minimal bleeding. Examples of cosmetic implant procedures in whichthe TD may be used may include, but are not limited to, skin, breast,face (cheek, brow), muscle (biceps, triceps, calf), and buttocksimplants, to name a few. Examples of medical device implants in whichthe TD may be used may include, but are not limited to, drug implantdevices, for example, insulin infusion pumps, cardiac pacemakers,artificial joints, implantable neurologic devices, implantable trackingand/or identification (for example, RFID) chips, to name a few. Theplacement of many implants, to minimize visible scarring, may involvecreating one or more paths to the implant zone. Method 5900 according tosome implementations will now be described as illustrated in FIG. 59 .The implementations and embodiments from FIGS. 54 and 55 involving thetreatment of cellulite are incorporated herein and may be modified asfollows.

Implementation 5900 to place a cosmetic implant may use same route(s) asfor cellulite treatment, however, the tip may be deployed to itstreatment configuration closer to implant zone. The width of the pathand the entrance incision is preferably the minimum size needed for theimplant to traverse the path from the opening incision to the implantpocket. In some implementations, the surgeon may have to open up anadditional incision to place implant; this may depend upon whether theimplant has a capsule or has gel that will be moved to through the pathto the pocket. The surgeon may create a pocket appropriately sized forthe implant to rest.

Step 5905 comprises making an entrance incision. In someimplementations, step 5905 may comprises making a stab incision in alocation that is not usually visible to the eye from a reasonabledistance, for example, the umbilicus/bellybutton and/or under the axillaand/or around the nipple in the case of a breast implant. The width ofthe entrance incision is preferably the minimum size needed for the TDtip and shaft to traverse the entrance incision. Although the implantmay be of a larger diameter, it may be preferable for optimizingtraction keep the entrance incision its minimum size until the path tothe implant zone and/or the implant pocket are created.

Step 5910 may comprise forming a tip deployment pocket similar to thatdepicted in 5411 a at FIG. 54 for receipt and/or reconfiguring of thelysing tip from its delivery configuration to its treatmentconfiguration. In some implementations, curved blunt scissors may beused to make this tip deployment pocket by for example inserting saidscissors up to its pivot point and/or opening/closing the scissors. Insome implementations, the tip deployment pocket may be approximately thesize of half of a postage stamp. For example, the tip deployment pocketmay have a width in the direction of the incision of about 1 cm.Similarly, the tip deployment pocket may have a length perpendicular tothe width of between about 1 cm to 2 cm. In some implementations, thesurgeon may desire to open an additional incision to place the implant;this may depend upon whether the implant has a capsule or has gel thatwill be moved to through the path to the pocket.

Step 5915 may comprise reconfiguring the lysing tip within the tipdeployment pocket for receipt and/or reconfiguring of the lysing tipfrom its delivery configuration to its treatment In someimplementations, a surgeon may make such a wide entrance incision thatthe lysing tip may even fit through the incision in the treatmentconfiguration. In some implementations, the TD may be deployed through acannula and once within the tip deployment pocket may be reconfiguredfrom its delivery configuration to its treatment configuration. In otherimplementations, the lysing tip and/or grasping/control means may beinserted through the incision to the tip deployment pocket in which thelysing tip and grasping/control means may be coupled together in thetreatment configuration.

Step 5920 may comprise forming one or more paths to one or more implantzones as depicted in FIG. 54 a . In some implementations, this maycomprise activating one or more lysing members and then advancing thelysing tip towards the implant zone. This may be done for example in aseries of substeps by advancing the lysing tip and pulling it back in arepeated fashion. The surgeon may create additional paths adjacent tothe initial path, thus creating a triangular and/or cone shape betweenthe incision and the implant zone. As shown in FIG. 54 a , if thetreatment zone 5402 has a width wider than the width of the path, thesurgeon may, either right before or simultaneously with movement of thetip into the treatment zone, manipulate the treatment zone, such as bytraction (either manual or using instrumentation), into the path of thelysing tip. The width of the path may be the minimum dimensions neededfor the implant to traverse the path.

Step 5921 may comprise the surgeon creating an implant pocketappropriately sized for the implant to rest.

Step 5922, perhaps after removal of the TD, may comprise expanding theentrance incision to the minimum dimensions required for the maximumdimension of the implant to traverse the entrance incision.

Step 5925 may comprise, after lysing the tissues, applying energy to theimplant zone with the TD or a separate TMT. In some implementations, asurgeon may reduce bleeding by use of such instruments as a bovie probeand/or grasper/clamp. In alternative implementations, the surgeon mayuse the lysing members of the lysing tip and/or the energy window of theTMT to modify tissues for various intended results, including but notlimited to skin tightening and fat modification. In suchimplementations, the energy window of the TMT may be configured todeliver the following types of energy modalities including but notlimited to laser, intense pulse light, resistive heating, radiant heat,thermochromic, ultrasound, and/or microwave.

Step 5930 may comprise rotating and/or reconfiguring the lysing tip backinto the delivery configuration in either the treatment area and/or thetip deployment pocket and/or the path, if it is sufficiently wide, andwithdrawing the lysing tip and/or cannula back through the incision.

Step 5935 may comprise delivery and/or placement and/or securing of theimplant according to manufacturers' recommendations and/orspecifications and/or qualified surgeons' modifications. Securing of theimplant may include, but not be limited to, placing sutures, staples,and/or retention devices either in the tissues around the implant and/oralong the tissues along the path of the implant and/or the tissues alongthe entrance incision.

Step 5940 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

An example of a method 6000 for a capsulotomy and/or a capsulectomy willnow be described as illustrated in FIG. 60 . As breast implants may beviewed by the human body as a foreign object, scar tissue may developaround a breast implant over a 3 to 4 year period. This capsule ofscar/fibrous tissue may be of a spherical shape. Step 6005 may comprisemaking an entrance incision as previously described herein. Step 6010may comprise creating a tip deployment pocket near to or away from theentrance incision as previously described herein. Step 6015 may compriseinserting the TD in its delivery configuration and re-configuring the TDto its treatment configuration as previously described herein. Step 6020may comprise activating the TD and creating paths to the treatment zone,in this embodiment, around the capsule. Step 6025 may compriseactivating the TD and lysing the adhesions attaching to the capsule tothe implant and/or surrounding tissues by moving along the periphery ofcapsule. Step 6028 may comprise returning the lysing tip to a deploymentconfiguration. Step 6030 may comprise removal of the TD as previouslydescribed herein. Step 6035 may comprise separation and/or removal of atleast a portion of the capsule from the surrounding tissues and/or theimplant. In some implementations, step 6035 may be performed before step6030.

Step 6035 may comprise withdrawal of the lysing tip. Step 6040 maycomprise closing the entrance wounds or surface incisions via glues,staples, adhesive skin closure strips, and/or sutures.

An example of a method 6100 for body lifting and skin excision will nowbe described as illustrated in FIG. 61 . An example of a use of thismethod includes tightening of sagging tissue on arms. Generally, thisprocedure involves undermining skin, excising a portion of said skin,and pulling tight the remaining skin.

Step 6105 may comprise making the skin incision near the underminingzone as previously described herein which may be under the arm pit andhydrating/tumescent the area to be undermined as stated previously. Thearea to be undermined may be 10 to 20 cm beyond the location of theincision demarking the skin to be removed. Step 6110 may comprisewidening the entrance incision and creating the tip deployment pocket asstated previously. Step 6115 may comprise inserting the lysing tip inits delivery configuration into the tip deployment pocket and deployingthe lysing tip to the treatment configuration.

Step 6120 may comprise undermining/lysing skin in locations beneath theskin to be removed as well as locations adjacent thereto in order tohave sufficient tissue to pull the edges of the remaining tissuetogether to be closed. In this step, fat may be heated/removed as well.Step 6125 may comprise withdrawal of the lysing tip.

Step 6130 may comprise making the incision, which may be in the form ofan ellipse, demarking the edges of the tissue to be removed. Step 6135may comprise removal of the tissue comprising the shape of the ellipse.Step 6140 may comprise sewing fascia together to take the stress off ofthe skin when the edges of the skin are sewn together. Step 6145 maycomprise closing wounds or surface incisions via glues, staples,adhesive skin closure strips, and/or sutures.

Modification of localized cutaneous neurologic symptoms. E.g., localizeditching or burning. E.g., Notalgia paresthetica is an intense localizeditching area usually on the back. Dissecting the skin in the NP area aswell as around it may denervate or alter the neurologic pattern in areathus may provide relief. Post zoster neuralgia is an often painfulcondition that may feel like it is coming from the skin in patients whohave suffered from shingles. Dissecting the skin in the post zosterneuralgia area as well as around it may denervate or alter theneurologic pattern in area thus may provide relief. Other itching andpainful conditions of the skin possibly related to neurologicalterations may be improved by dissection with TD.

It will be understood by those having skill in the art that changes maybe made to the details of the above-described embodiments withoutdeparting from the underlying principles presented herein. For example,any suitable combination of various embodiments, or the featuresthereof, is contemplated.

Any methods disclosed herein comprise one or more steps or actions forperforming the described method. The method steps and/or actions may beinterchanged with one another. In other words, unless a specific orderof steps or actions is required for proper operation of the embodiment,the order and/or use of specific steps and/or actions may be modified.

Throughout this specification, any reference to “one embodiment,” “anembodiment,” or “the embodiment” means that a particular feature,structure, or characteristic described in connection with thatembodiment is included in at least one embodiment. Thus, the quotedphrases, or variations thereof, as recited throughout this specificationare not necessarily all referring to the same embodiment.

Similarly, it should be appreciated that in the above description ofembodiments, various features are sometimes grouped together in a singleembodiment, figure, or description thereof for the purpose ofstreamlining the disclosure. This method of disclosure, however, is notto be interpreted as reflecting an intention that any claim require morefeatures than those expressly recited in that claim. Rather, inventiveaspects lie in a combination of fewer than all features of any singleforegoing disclosed embodiment. It will be apparent to those havingskill in the art that changes may be made to the details of theabove-described embodiments without departing from the underlyingprinciples set forth herein.

Furthermore, the described features, components, structures, steps, orcharacteristics may be combined in any suitable manner in one or morealternative embodiments and/or implementations. In other words, any ofthe features, components, structures, steps, or characteristicsdisclosed in any one disclosed embodiment may be combined with features,components, structures, steps, or characteristics of other disclosedembodiments. The scope of the present invention should, therefore, bedetermined only by the following claims.

The invention claimed is:
 1. A method for performing an electrosurgicalprocedure, the method comprising the steps of: delivering a lysing tipthrough an entrance incision into a patient's body, wherein the lysingtip comprises: at least one bead comprising an at least substantiallyelectrically non-conductive surface; and at least one lysing segmentextending within a recess defined, at least in part, by the at least onebead, wherein the at least one bead protrudes both distally andproximally relative to the at least one lysing segment; forming opposingtissue planes using the lysing tip to create an implant pocket; andinserting an implant through the entrance incision and into the implantpocket.
 2. The method of claim 1, wherein the implant comprises at leastone of a pump, a cardiac pacemaker, a neurologic device, a trackingdevice, and an ID chip.
 3. The method of claim 1, wherein the implantpocket comprises a width dimension extending parallel to a length of theentrance incision, and wherein the width is greater than the length ofthe entrance incision.
 4. The method of claim 1, wherein the implantpocket comprises at least one shape selected from the group of: asquare, a rectangle, and a circle.
 5. The method of claim 1, wherein theimplant comprises a cosmetic implant.
 6. The method of claim 5, whereinthe cosmetic implant comprises at least one of a skin implant, a breastimplant, a face implant, and a muscle implant.
 7. The method of claim 1,further comprising forming a tip deployment pocket adjacent to theentrance incision.
 8. The method of claim 1, wherein the at least onebead comprises a plurality of beads.
 9. The method of claim 1, furthercomprising using the lysing tip to perform reverse dissection wherebythe lysing tip is moved in a proximal direction to dissect tissue. 10.The method of claim 9, wherein the step of using the lysing tip toperform reverse dissection is performed during the step of formingopposing tissue planes using the lysing tip to create an implant pocket.11. A method for performing a surgical procedure, the method comprisingthe steps of: delivering a lysing tip through an entrance incision intoa patient's body, wherein the lysing tip comprises: at least one beadcomprising an at least substantially electrically non-conductivesurface; and at least one lysing segment extending within a recessdefined, at least in part, by the at least one bead, wherein the atleast one bead protrudes both distally and proximally relative to the atleast one lysing segment; creating an implant pocket; and inserting animplant through the entrance incision and into the implant pocket. 12.The method of claim 11, wherein the at least one bead comprises aplurality of beads.